Print this pageSubintimal Angioplasty is Superior to Silverhawk Atherectomy for the Treatment of Occlusive Lesions of the Lower Extremities
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Jeffrey E. Indes, MD1, Takao Ohki, MD Phd2, Evan C. Lipsitz, MD1, Frank J. Veith, MD3, Taylor Reed, PA1, Allen B. Yeroushalmi, BS1, Evan Deutsch, MD1, Larry A. Scher, MD1, Nicholas J. Gargiulo, III, MD1, William D. Suggs, MD1.
1Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA, 2Jikei University School of Medicine, Tokyo, Japan, 3New York University, New York, NY, USA.
Objective: To evaluate the early results and need for secondary interventions in patients undergoing atherectomy, compared to those undergoing subintimal angioplasty (SIA) for lower extremity arterial occlusive disease.
Methods: From September 2005 through July 2006, 27 patients underwent atherectomy of 44 lesions with the Silverhawk device. Patient symptoms, degree of restenosis or occlusion, and need for secondary interventions were recorded at 3, 6 and 12 months. These patients were compared to 39 patients undergoing subintimal angioplasty for lower extremity arterial occlusions over a previous 2.5 year period.
Results: Sixteen women and 11 men with an average age of 65 years (range 37-85 years) underwent atherectomy of 44 lesions with a technical success of 100%. Ten patients had occlusions (TASC C/D). In the 10 patients with occlusions at initial follow up, symptoms improved in 9 patients and worsened in 1 patient. Nine of 10 patients with occlusive lesions required operative reintervention for critical limb ischemia on the basis of re-occlusion of these lesions, where as, 1 of 17 (6%) patients treated for stenotic lesions required reintervention. The mean time to reintervention was 4.6 months (range 1 - 10 months). The symptomatic patency of this group at 11 months was 21%. SIA was technically successful in 34 of 39 patients (87%) treated for lower extremity occlusions. In the 34 technically successful SIAs, pain completely resolved (14/14) and areas of gangrene (21/25) healed. The symptomatic patency rate at 12 months for this group (intention-to-treat basis) was 68%.
Conclusion: Patients undergoing atherectomy for stenotic lesions had a lower rate of reintervention, than those treated for occlusive lesions. SIA appears superior to atherectomy for the treatment of occlusive disease.
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