Application of directional atherectomy combined with paclitaxel-coated balloon angioplasty in treatment of femoropopliteal occlusion

Abstract

Objective: To evaluate the safety and effect of directional atherectomy (DA) combined with paclitaxel-coated balloon (PCB) angioplasty in treatment of atherosclerotic lesions in femoropopliteal artery. Methods: Seventeen cases with femoropopliteal occlusion[mean age of (73.2±7.5) years-old; 11 male and 6 female] were analyzed. In 14 cases (82%) , the Rutherford level of the affected limb was >4 grade, presented with critical limb ischemia, underwent treatment with DA and PCB angioplasty under filter protection between September 2016 and August 2017. Dual antiplatelet therapy was indicated per-and post-operation. The ankle-brachial index (ABI) was detected before the intervention, after 3, 6 and 12 months. Also clinical examination and target lesion duplex ultrasound scans or computed tomographic angiography (CTA) were done in the observation period. Results: There were 17 cases enrolled, the treated lesion length was (286.1±69.4) mm. Successful recanalization of all target lesions, one refractory stenosis was treated with bailout stenting. The technical success rate was 94.1%. In eight cases with toe necrosis before operation, foot finger amputations were performed after procedure, to reach complete wound healing and/or preserve deambulation. The post-operation ABI was significantly higher than per-operation (0.99±0.10 vs. 0.30±0.19, t=15.31, P<0.05) . The mean follow-up was (7.4±3.8) months (3-14 months) . During follow-up, no restenosis requiring re-intervention was found, the primary patency was 100%, and no DA-related adverse event and symptom recurrence was observed, with the limb salvage rate of 100%. Conclusion: The DA combined with PCB might be an effective and safe method with a promising high rate of patency. Key words: Femoropopliteal occlusion; TurboHawk directional atherectomy; Paclitaxel-coated balloon