title: Capture and removal of atheromatous plaque, from the lesion site, post directional atherectomy of long, in-stent restenotic superficial femoral artery lesions.
abstract: The clinical impact of embolic debris released during lower-limb interventions is a source of discussion and controversy. Yet, the sheer magnitude of their number, overall area, and morphology suggest significance, especially in complex and high-risk patients. Technologies designed for lowering embolic burden are required to improve peripheral vascular intervention (PVI) outcomes and to reduce complication rates in a timely and cost-effective manner. This work details capture and removal of atheromatous plaque during post-atherectomy dilatation of long, in-stent, restenotic superficial femoral artery (SFA) lesions in two complex comorbid patients. In both cases, embolic removal was obtained by deployment of an embolic protection device (EPD) prior to the main intervention and by postdilating the lesion using the Proteus aspiration balloon. Captured and removed particles were analyzed and compared for content, count, and dimensions from both the EPD and the Proteus device. Both cases were successfully resolved, as determined by angiography with no sequelae. In both procedures, Proteus surpassed the EPD in the magnitude of removed embolic shower. In case 1, the Proteus balloon captured 228 particles, with a mean major axial dimension of 0.4 ± 0.43 mm (range, 0.12-3.29 mm), while the distally positioned EPD captured 16 particles with a mean major axial dimension of 0.88 ± 1.25 mm. Similarly, 719 particles of a mean 0.24 ± 0.43 mm major axial dimension (range, 0.03-4.83 mm) were recovered in case 2. The capture efficiency presented by the Proteus device over the EPD suggests its potential to serve as a viable tool in complex PVIs, particularly in the dilatation of irregular atherectomized lesions.
authors.affiliation: Community Health Care System Munster, Indiana, USA. prakashmakam@comcast.net
authors.forename: Prakash
authors.initials: P
authors.lastname: Makam
mesh_terms: D000368:Aged; D000792:Angiography; D000800:Angioplasty, Balloon; D017073:Atherectomy / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D058226:Plaque, Atherosclerotic / Q000628:therapy*; D013396:Suction; D016896:Treatment Outcome