Early experience and midterm follow-up results with a new,rotational thrombectomy catheter |
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Authors: | Bérczi Viktor Deutschmann Hannes A Schedlbauer Peter Tauss Josef Hausegger Klaus A |
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Institution: | (1) Department of Radiology, University Hospital,, Auenbruggerplatz 9, A-8036 Graz, Austria, AUSTRIA |
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Abstract: | Purpose: To assess
the efficacy and safety of the Rotarex rotational thrombectomy catheter in
treating occlusions of the femoropopliteal arteries. Methods: The Rotarex catheter (Straub Medical,
Switzerland) is a rotational thrombectomy device which is supposed to be able
to remove fresh and partially organized clot material from an acutely or
subacutely occluded vessel. Nineteen limbs of 18 patients (10 women, 8 men;
mean age 72.9 ± 7.3 years) with acute or subacute (23 ± 16 days)
occlusions of the middle or distal third of the superficial femoral artery or
the popliteal artery were treated. The occlusions were 3–20 cm long.
Results: Thrombectomy was technically successful
in 15 of 19 vessels (79%). The primary procedural success including additional
procedures such as angioplasty and/or stent-graft placement in 17 limbs was
94%. The mean ankle-brachial index improved from 0.36 ± 0.26 (before
thrombectomy) to 0.81 ± 0.21 (2 days after the procedure) (p = 0.012). Clinical symptoms shifted to at least one
Fontaine stage lower in 13 limbs. As complications we observed two perforations
(arteries showing heavily calcified plaques), one arteriovenous fistula and
three distal embolizations. One perforation, the fistula and one intimal tear
after percutaneous transluminal angioplasty were treated with covered stents;
the three distal embolizations were treated successfully with aspiration or
Rotarex thrombectomy. In the other perforation the intervention was terminated.
None of the complications needed surgical treatment. The complication rate was
31.5%. Follow-up studies showed three early (4–11 days) and six late
(1–6 months) reocclusions. The cumulative primary patency rate was 68
± 12% at 3 months, and 39 ± 13% at 6, 12 and 19 months; the secondary
patency rate was 68 ± 12% at 3 months and 53 ± 13% at 6, 12 and 20
months. Conclusion: The Rotarex thrombectomy
catheter is effective and quick in treating acute and subacute occlusions of
the superficial femoral and popliteal arteries. It should not be used in
arteries with heavily calcified plaques because of the risk of perforation.
Limited long-term patency is mainly due to the complexity of the underlying
lesion. Our results suggest that the Rotarex mechanical thrombectomy catheter
is effective and might serve as an alternative treatment modality to
intra-arterial lysis. |
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Keywords: | |
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