Peripheral Atherectomy with the Pullback Atherectomy Catheter: Procedural Safety and Efficacy in a Multicenter Trial

Abstract

Purpose: To report the initial results of a newly designed catheter for percutaneous circumferential atherectomy in patients with lower extremity atherosclerotic occlusive disease. Methods: The Pullback Atherectomy Catheter (PAC) is an over-the-wire device that circumferentially debulks atherosclerotic lesions in peripheral arteries up to 6 mm in diameter. Pullback atherectomy with or without adjunctive balloon angioplasty was attempted in 190 patients (246 lesions) with lower extremity lesions ≤ 7.0 cm in length and a diameter stenosis > 50%. Results: Angiographic success was accomplished in 95% (234/246) of the of the lesions attempted. The baseline ankle-brachial index rose from 0.61 ± 0.20 to 0.83 ± 0.20 (p < 0.001) at 24 hours after the procedure. There were no major complications (distal emboli, dissection, thrombosis, or perforation requiring surgical correction) attributable to pullback atherectomy. Conclusions: The acute results of pullback atherectomy demonstrate an extremely high technical success rate and an excellent safety record for lower extremity percutaneous revascularization. The catheter facilitates debulking longer lesions, but it is limited to small-diameter (≤ 6 mm) peripheral vessels.