Effects of high-speed rotational atherectomy in peripheral artery disease patients with calcified lesions: a retrospective multicenter registry

Load-sharing characteristics of stenting and post-dilation in heavily calcified coronary artery

In this work, stenting in non-calcified and heavily calcified coronary arteries was quantified in terms of diameter-pressure relationships and load transfer from the balloon to the artery. The efficacy of post-dilation in non-calcified and heavily calcified coronary arteries was also characterized in terms of load sharing and the changes in tissue mechanics. Our results have shown that stent expansion exhibits a cylindrical shape in non-calcified lesions, while it exhibits a dog bone shape in heavily calcified lesions. Load-sharing analysis has shown that only a small portion of the pressure load (1.4 N, 0.8% of total pressure load) was transferred to the non-calcified lesion, while a large amount of the pressure load (19 N, 12%) was transferred to the heavily calcified lesion. In addition, the increasing inflation pressure (from 10 to 20 atm) can effectively increase the minimal lumen diameter (from 1.48 mm to 2.82 mm) of the heavily calcified lesion, the stress (from 1.5 MPa to 8.4 MPa) the strain energy in the calcification (1.77 mJ to 26.5 mJ), which associated with the potential of calcification fracture. Results indicated that increasing inflation pressure can be an effective way to improve the stent expansion if a dog bone shape of the stenting profile is observed. Considering the risk of a balloon burst, our results support the design and application of the high-pressure balloon for post-dilation.

PERCUTANEOUS TRANSLUMINAL ROTARY ATHERECTOMY IN PATIENTS WITH ATHEROSCLEROTIC LESIONS OF BELOW THE KNEE ARTERIES

OBJECTIVE

The aim: To determine the effectiveness of the combination of the percutaneous transluminal rotational atherectomy (PTRA) techniques with plain old balloon angioplasty (POBA) and POBA monotherapy (POBA-mono) in endovascular treatment (ET) of patients with occlusive-stenotic lesions below the knee (BTK) arteries.

PATIENTS AND METHODS

Materials and methods: We studied two groups, the main included patients (n=9) aged who underwent PTRA and POBA of BTK arteries, and the comparative group (POBA-mono) of patients (n=24) who underwent POBA monotherapy of BTK arteries.

RESULTS

Results: Thrombosis of the reconstructed segments in the target arteries after 12 months was diagnosed in 95% of patients of the control and 1 - main groups (Ft, p=0.00001). Healing of trophic ulcers of the foot in the first month after ET was observed in 78% (n=7) of patients of the main group and in 13% (n=3) of the control group (χ2 (1, n=33) = 10.2961; p=0.0013), and after 3 months - in 100% (n=9) and 83% (n=20) of patients in the respective groups.

CONCLUSION

Conclusions: The combination of PTRA with POBA reduces the probability of repeated violations of the patency of the target artery. In addition, it increases the healing efficiency of trophic ulcers of the LE compared to POBA monotherapy.

Rationale and Design of a Prospective, Multicenter, Single-Arm Clinical Trial to Investigate the Safety and Effectiveness of Rotablator Atherectomy System as an Adjunctive Device for Endovascular Treatment of Occlusive Atherosclerotic Lesions in Below-the-Knee Arteries With Critical Limb Ischemia (RESCUE-BTK)

Background: Endovascular treatment with balloon angioplasty plays a major role in revascularization of below-the-knee (BTK) arteries in patients with critical limb ischemia (CLI). However, with severely calcified lesions, achieving optimal revascularization with balloon angioplasty alone is difficult. Therefore, we are evaluating the safety and effectiveness of the Rotablator atherectomy system as an adjunctive device in the treatment of severely calcified lesions in BTK arteries in the RESCUE-BTK trial, a multicenter, single-arm, open-label, exploratory investigator-initiated clinical study of medical devices. In this paper we describe the design of the trial.

Methods and Results: Seventeen patients with CLI in whom balloon angioplasty has failed are enrolled in the study. The primary endpoint is the procedural success rate of balloon angioplasty after rotational atherectomy. Success is defined as the fulfillment of 3 requirements upon assessment by the core laboratory: (1) final residual diameter stenosis <50%; (2) the absence of a delay in flow or vessel perforation in the target artery, or both; and (3) brisk antegrade flow to the foot. Key secondary endpoints are the number of complications associated with the trial procedures and the limb salvage rate. Participants are followed-up for 6 months after the trial procedures.

Conclusions: The RESCUE-BTK trial will clarify the safety and effectiveness of the adjunctive use of the Rotablator system in severely calcified lesions of BTK arteries in patients with CLI.