eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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1/2020
vol. 16
 
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abstract:
Original paper

Comparison of long-term outcomes after directional versus rotational atherectomy in peripheral artery disease

Adam Janas
1
,
Krzysztof Milewski
1
,
Piotr Buszman
1
,
Aleksandra Kolarczyk-Haczyk
1
,
Wojciech Trendel
1
,
Maciej Pruski
1
,
Wojciech Wojakowski
2
,
Paweł Buszman
1
,
Radosław S. Kiesz
3

  1. Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
  2. Third Division of Cardiology, Medical University of Silesia, Katowice, Poland
  3. San Antonio Endovascular & Heart Institute, San Antonio, USA
Adv Interv Cardiol 2020; 16, 1 (59): 76–81
DOI: https://doi.org/10.5114/aic.2020.93914
Online publish date: 2020/04/03
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Introduction
The rate of atherectomy utilization in peripheral artery diseases (PAD) is growing. The two atherectomy devices available on the market and used most frequently are the directional and rotational ones. Nonetheless, there is a lack of direct comparison between these two types of atherectomy in PAD.

Aim
To compare the long-term outcomes after PAD endovascular revascularization with two types of atherectomies: rotational (AR) (Phoenix Philips) and directional (AD) (SilverHawk Medtronic).

Material and methods
This was a single-center, retrospective study of obstructive and symptomatic PAD patients who underwent revascularization with atherectomy. The endpoints were considered as target lesion revascularization (TLR), death, amputations and bailout stenting (BS).

Results
The AR group consisted of 97 patients, while the AD group consisted of 85 individuals. There were no significant differences between the groups in terms of baseline characteristics except for an increased critical limb ischemia (CLI) prevalence in the AR group. The mean follow-up for AD and AR was 282.6 ±147.4 and 255.7 ±186.1 days, respectively (p = 0.44). There were no significant differences in the death rate (AD: 1 (1.7%) vs. AR: 5 (5.7%); p = 0.54), amputations (AD: 2 (2.3%) vs. AR: 5 (5.7%); p = 0.45) or bailout stenting (AD: 2 (2.3%) vs. AR: 3 (3.2%); p = 0.74), whereas TLR was more frequent in the AD group (AD: 25 (29%) vs. AR: 15 (15.9%; p = 0.03). The Kaplan-Meier analysis showed no significant differences between the groups in time to TLR, amputation or death.

Conclusions
In this hypothesis-generating study the AR had a lower rate of TLR when compared to the AD. Nevertheless, this should be confirmed in further controlled randomized trials.

keywords:

peripheral arterial disease, critical limb ischemia, atherectomy, claudication
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