Journal of Nippon Medical School: Vol.67 No.5 page.335

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ArticleTitle Peripheral Directional Atherectomy Evaluated with a Rotational Digital Angiography System

AuthorList Hiroshi Kawamata, Tatsuo Kumazaki, Hiroyuki Tajima and Pascal Niggemann

Affiliation Department of Radiology, Nippon Medical School

Language EN

Volume 67

Issue 5

Year 2000

Page 335-341

Received May 10, 2000

Accepted June 6, 2000

Keywords atherosclerosis, peripheral vascular disease, atherectomy, angiography

Abstract Background: One of the factors that affect the recurrence rate after peripheral directional atherectomy (DA) is the degree of residual stenosis. A new method of peripheral DA to reduce residual stenoses was evaluated with a rotational digital angiography (RDA) system that provides both angiography and fluoroscopy at multiple projections within 360 degrees. Patients and methods: Between March 1995 and July 1999, severe short segmental stenoses of six iliac arteries and two superficial femoral arteries (SFA) in eight patients were treated with the Simpson DA catheter under RDA system guidance. After pre-procedural RDA evaluation, the first series of DA were performed under ordinary PA fluoroscopic guidance. The residual stenoses were evaluated with RDA. If the residual stenoses exceeded 30%, a second series of DA were performed covering the residual plaque with the cutter window of the DA catheter. To this purpose the fluoroscopy of the RDA system was fixed in the direction in which the residual stenoses were largest and most eccentric. The end point was defined to be a residual stenosis of less than 30% evaluated with the RDA system, and the procedures were repeated until the end point was achieved. Results: Five of six iliac artery lesions were curved at the pre-procedural RDA evaluation. After the first series of DA, only two of six iliac lesions but all SFA lesions achieved the end point. Among the four other iliac lesions, three achieved the end point with one or two additional series of DA using the RDA system guidance to control the selective cuts of the residual plaques. One patient had a residual stenosis of 50% because the procedure could not be completed by balloon rupture of the DA catheter. In the patients with iliac stenoses, there was no final residual stenosis in one, and the range was from 20% to 25% in the four patients. The residual stenoses were located on the greater curvature side of the curved artery in three of these four patients. Conclusion: The RDA system is a valuable tool in aiding redu

Correspondence to Hiroshi Kawamata, MD, Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
Kawamata/Radiology@nms.ac.jp

ArticleTitle	Peripheral Directional Atherectomy Evaluated with a Rotational Digital Angiography System
AuthorList	Hiroshi Kawamata, Tatsuo Kumazaki, Hiroyuki Tajima and Pascal Niggemann
Affiliation	Department of Radiology, Nippon Medical School
Language	EN
Volume	67
Issue	5
Year	2000
Page	335-341
Received	May 10, 2000
Accepted	June 6, 2000
Keywords	atherosclerosis, peripheral vascular disease, atherectomy, angiography
Abstract	Background: One of the factors that affect the recurrence rate after peripheral directional atherectomy (DA) is the degree of residual stenosis. A new method of peripheral DA to reduce residual stenoses was evaluated with a rotational digital angiography (RDA) system that provides both angiography and fluoroscopy at multiple projections within 360 degrees. Patients and methods: Between March 1995 and July 1999, severe short segmental stenoses of six iliac arteries and two superficial femoral arteries (SFA) in eight patients were treated with the Simpson DA catheter under RDA system guidance. After pre-procedural RDA evaluation, the first series of DA were performed under ordinary PA fluoroscopic guidance. The residual stenoses were evaluated with RDA. If the residual stenoses exceeded 30%, a second series of DA were performed covering the residual plaque with the cutter window of the DA catheter. To this purpose the fluoroscopy of the RDA system was fixed in the direction in which the residual stenoses were largest and most eccentric. The end point was defined to be a residual stenosis of less than 30% evaluated with the RDA system, and the procedures were repeated until the end point was achieved. Results: Five of six iliac artery lesions were curved at the pre-procedural RDA evaluation. After the first series of DA, only two of six iliac lesions but all SFA lesions achieved the end point. Among the four other iliac lesions, three achieved the end point with one or two additional series of DA using the RDA system guidance to control the selective cuts of the residual plaques. One patient had a residual stenosis of 50% because the procedure could not be completed by balloon rupture of the DA catheter. In the patients with iliac stenoses, there was no final residual stenosis in one, and the range was from 20% to 25% in the four patients. The residual stenoses were located on the greater curvature side of the curved artery in three of these four patients. Conclusion: The RDA system is a valuable tool in aiding redu
Correspondence to	Hiroshi Kawamata, MD, Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan Kawamata/Radiology@nms.ac.jp