Luminal Gain After Atherectomy Measured by Intravascular Ultrasound (IVUS) and Impact on Short-term Results

Abstract

Atherectomy has been proposed to debulk lesions prior to intervention. Data on the degree of luminal gain after this procedure are not available. We evaluated immediate luminal gain, measured by intravascular ultrasound (IVUS) following various types of percutaneous atherectomy. Short-term patency and residual stenosis was measured by duplex ultrasound (DUS). We prospectively collected data on 79 consecutive lower extremity revascularization procedures where atherectomy was performed. Severity of arterial stenosis was measured using angiography and IVUS. IVUS was used to identify severe (>70%) stenosis and the percent stenosis pre and immediately post atherectomy. The difference represented percent luminal gain by atherectomy alone. Comparisons were analyzed using various atherectomy techniques including excimer laser, excisional rotational, and orbital atherectomy. Peak systolic velocities from pretreatment DUS were compared with post treatment DUS at 1 month follow up to evaluate effectiveness of atherectomy type in relation to degree of stenosis. We performed lower extremity angiography with atherectomy on 79 legs in 75 patients with an average age of 75.4 years (range, 40-91 years). Procedures included excimer laser (n = 35), excisional rotational (n = 33), and orbital atherectomy (n = 11). Sixty-eight above-knee (ATK) atherectomy and 28 below-knee (BTK) atherectomy procedures were performed. Patients presented with Rutherford Class 3 (62%; n = 49), Class 4 (16%; n = 13), Class 5 (19%; n = 15), and Class 6 (1.3%; n = 1). Atherectomy was performed in 68 vessels ATK and 28 vessels BTK with 16% of patients having multivessel intervention. In-stent stenosis was the indication for atherectomy in 22 vessels (28%). Average luminal gain was 23.6% for ATK atherectomy (range, 10%-39%) and 24.2% for BTK vessels (range, 11%-34%; P > .05). There was no difference in luminal gain based on atherectomy type, laser (25%), excisional rotational (23%) and orbital atherectomy (23%; P > .05. There was also no difference in luminal gain based on gender, male 26% and female 24% (P > .05). Using DUS pre and post angiogram with intervention, we noted an average decrease in PSV of 90 cm/s, 122.4 cm/s, 106.9 cm/s, and 31.4 cm/s for the common femoral artery, superficial femoral artery, above-knee popliteal artery, and below-knee popliteal artery, respectively. Atherectomy results in an average luminal gain of 24% regardless of location of atherectomy (ATK vs BTK), type of atherectomy device, or gender. This is associated with high rates of patency in both BTK and ATK vessels at short-term follow-up.