Print this pageEmbolic Complications Associated with the Silverhawk Atherectomy Catheter
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Charlie C. Cheng, MD1, Anish Rawat, MD1, Jean Bismuth, MD1, Carlos Bechara, MD1, Tam Huynh, MD1, Imran T. Mohiuddin, MD2, Peter H. Lin, MD1, Eric K. Peden, MD2, Alan B. Lumsden, MD2.
1Baylor College of Medicine, Houston, TX, USA, 2The Methodist Hospital, Houston, TX, USA.
OBJECTIVES: Advancement in catheter-based technologies has allowed for plaque excision from the lower extremity arteries. Complications resulting from percutaneous atherectomy are limited in the published literature. In this study, we describe our experience with embolic complications from the use of the Silverhawk atherectomy catheter.
METHODS: A retrospective review of patients with lower extremity ischemia treated with the Silverhawk catheter (FoxHollow Technologies, Redwood City, CA) was performed. Immediate complications resulting from embolic events were identified, and analyzed for patient comorbidities, lesion location, number of run-off vessels, interventions used, and outcomes.
RESULTS: During a 21 month period, 32 lesions in 15 patients with 16 limbs underwent atherectomy. There were 5 men (33%), and the average age of the patients was 66.7 years (range, 38 to 85 years). All limbs were classified in Rutherford category 4 to 6. Six limbs (38%) had embolic complications. The average number of run-off vessels, and the locations of the lesions treated were similar in patients with and without embolic events. Four of the six patients with embolic events and 9 of 10 with uncomplicated atherectomies had adjunctive procedures. These procedures included angioplasties and stentings. Embolic complications were associated with passage of the atherectomy catheter, not adjunctive procedures. The management of these embolic complications included observation, retrieval of debris with aspiration catheter, overnight thrombolytic infusion, bypass, and amputation.
CONCLUSIONS: Directional atherectomy with the Silverhawk catheter can be associated with embolic complications. No predicting factors were noted, and these embolic events can lead to limb loss. One should exercise caution during intervention with the atherectomy catheter.
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