title: A comparative study of percutaneous atherectomy for femoropopliteal arterial occlusive disease.
abstract: BACKGROUND
  SilverHawk™ directional atherectomy has been used to treat more than 300 thousand cases of lower extremity atherosclerotic occlusive disease in the world since it was approved by FDA in 2003. This study aimed to analyze the safety and effectiveness of symptomatic femoral popliteal atherosclerotic disease treated by directional atherectomy (DA).
  
  
  METHODS
  Clinical data of all consecutive patients treated with percutaneous atherectomy utilizing the SilverHawk™ plaque excision was retrospectively analyzed. The anatomic criteria of the atherosclerotic lesions were divided into four types: type I stenosis; type II occlusion; type III in-stent restenosis; type IV stent occlusion.
  
  
  RESULTS
  There were 160 patients treated during the study period. Intermittent claudication in 75 patients (47%), rest pain in 55 patients (34.5%) and tissue loss in 30 patients (18.5%). The number of patients was 72, 15, 49 and 24 in type I, II, III and IV lesions, respectively. Technical success rate was 98.6%, 93.3%, 97.9% and 91.7% in type I, II, III and IV lesions, respectively. Debris of intimal plaque was captured by protection device in 92 patients (71.3%). The mean follow-up period was 23.5±10.4 months. Restenosis rate of type I to IV lesions was 21%, 36%, 36% and 40% respectively. Restenosis rate in type I lesion was significantly lower than that in type III and IV lesions (P<0.05). Patients with tissue loss responded to revascularization as follow: type I, 11/13 healed or reduced (84.6%), type II, 3/3 patients improved (100%), type III, 5/6 patients improved (83.3%) and type IV 4/4 healed (100%). In type IV group, four patients had in-stent thrombosis found by postoperative Duplex ultrasonography. They all underwent DA after catheter-directed thrombolysis with good angiographic results.
  
  
  CONCLUSIONS
  Percutaneous DA is safe and effective for both de-novo atherosclerotic and in-stent stenotic or occlusive lesions. Thrombolysis before plaque excision is recommended in case of in-stenting thrombosis.
authors.affiliation: Department of Vascular Surgery, XuanWu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China - 15901598209@163.com.
authors.forename: Yongquan
authors.initials: Y
authors.lastname: Gu
authors.affiliation: Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
authors.forename: Mahmoud B
authors.initials: MB
authors.lastname: Malas
authors.affiliation: Department of Vascular Surgery, XuanWu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China.
authors.forename: Lixing
authors.initials: L
authors.lastname: Qi
authors.affiliation: Department of Vascular Surgery, XuanWu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China.
authors.forename: Lianrui
authors.initials: L
authors.lastname: Guo
authors.affiliation: Department of Vascular Surgery, XuanWu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China.
authors.forename: Jianming
authors.initials: J
authors.lastname: Guo
authors.affiliation: Department of Vascular Surgery, XuanWu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China.
authors.forename: Hengxi
authors.initials: H
authors.lastname: Yu
authors.affiliation: Department of Vascular Surgery, XuanWu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China.
authors.forename: Zhu
authors.initials: Z
authors.lastname: Tong
authors.affiliation: Department of Vascular Surgery, XuanWu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China.
authors.forename: Xixiang
authors.initials: X
authors.lastname: Gao
authors.affiliation: Department of Vascular Surgery, XuanWu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Vascular Surgery, XuanWu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China.
authors.forename: Zhonggao
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D017073:Atherectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002681:China; D003251:Constriction, Pathologic; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000503:physiopathology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency