| Part one The clinical curative effect of the Silverhawk atherectomy catheter inthe lower extremity atherosclerotic occlusive diseaseObjective: The Silverhawk atherectomy catheter is a novel therapeutic apparatus in treatingperipheral arterial disease, the working principle is reconstructing the stenotic or occlusive arterylumen by cutting off the atherosclerotic plaque. The aim of this study was to evaluate thehemodynamic changes and clinical effect of thetarget artery after the Silverhawk atherectomy.Materials and methods: Clinical data of19LEAOD patients with21limbs, who receivedSilverHawk plaque excision，were retrospectively collected from November2009to March2012.(male:14, female:5. Mean age:69.4±6.4years old, mean lower limb ischemia course:16.5±11.2months). In totally27lesions with peripheral occlusive disease (regardless of the lesions below thepopliteal artery) were treated use the Silverhawk catheter,11lesions were prediliated with smalldiameter balloon before the atherectomy. Additional balloon angioplasty was used in8lesions andstenting in5lesions. Embolism protection devices were used in10processes of atherectomy in thisstudy. Evaluated the plaque excision technical success rate, the success rate of endovasculartreatment and the clinical improvement of symptoms. And analysed the changes of ABI and theblood flow velocity of the distal outflow tract before and after the treatment using paired t test. Thefollow-up was taken1,3,6,and12months after the treatment.Results:1. Technical success rate was achieved in27lesions(100%). And29.7%(8/27) lesionsachieved procedural success after additional balloon angioplasty or stenting. No seriouscomplications such as pseudoaneurysmor artery perforation occurred during the procedure.2. Different improvement of lower limb ischemiaoccurred in all cases according to Rutherfordclassification,8cases (38.1%) markedly improved,12cases (57.1%) moderately improved, and1case (4.8%) minimally improved. And after the atherectomy, the clinical ischemic degree improvedto degree2,3,4and5in19.0%,14.3%,42.9%and23.8%of the patients. The average follow-upwas5.2months, no amputation, target vascular restenosis happened. 3. The postoperative ABI of21limbs were significantly higher than those before treatment (0.85+/-0.07vs0.23+/-0.08, p=0.000), and distal outflow blood velocity were obviously improved1month postoperativly (68.67+/-6.55cm/s vs31.63+/-9.99cm/s, p=0.000).Conclusion: l. Silverhawk atherectomy is a method of high technology success rate and littlecomplication in the treatment of lower extremityatherosclerotic occlusive disease.2. Silverhawk atherectomy can obviously improve the limb clinical ischemia symptomsand theblood dynamics of target artery. Besides, the distant body blood perfusion increased significantlyafter the treatment.3. Compared with the traditional endovscular treatment Silverhawk atherectomy have certainadvantages, but further study are still needed for the middle and long term clinical outcome.Part2Analysis of different factors influencing the Silverhawk atherectomyObjective: According to detailed research about27atherectomy lesions, To evaluate the influenceof different factors to the efficiency of cutting plaque, the clinical improvement, and technicalprocedure during and after the atherectomy; To evaluate the application value of theEPD andadjunctive therapy after the operation.Materials and methods: Collected detailed date of27lesions which suffered Silverhawkatherectomy(mean length:8.53+/-3.03cm). Lesions distribution: iliac artery:3, superficial femoralartery:19, in-stent occlusion:1, and popliteal artery:4. Stenosis degree classification: mild stenosis:2, moderate stenosis:10, severe stenosis:3, occlusion:12. Artery wall visible calcification wasobserved in10lesions (calcification group) using DSA, no specific calcification lesion wasobserved in17(not calcified group). all27lesions were suffered resecting plaques with theSilverhawk catheter,11lesions were prediliated with small diameter balloon before the atherectomy(prediliate group) and16were not prediliated (conventional group). Additional balloon angioplastywas used in8lesions and stenting in5lesions. Embolism protection devices were used in10processes of atherectomy.Results:1. The vessel diameter were obviously improved[0.00（0.14）vs3.06±0.51，p=0.000] andthe lumen stenosis rate decreased [100%（2.28%）vs53.12±6.28%，p=0.000]after balloonprediliated. But there was no significant difference in stenosis rate between prediliate group andconventional group after the atherectomy (22.69±9.69%vs23.32±8.48%,p=0.657). 2. Calcification group lesions required repeated cutting, residue stenosis rate in calcification groupwas higher than it in no calcification group after atherectomy (0.28+/-0.09vs0.19+/-0.06,p=0.004). Additional stenting in calcification group (40%) was higher than it in the no calcificationgroup (5.9%)(p=0.047).3. Mean atherectomy time was10.9min, vascular calcification increased the cutting time (F=74.57,p=0.000). There was positive correlation between the lesion length and the atherectomy time(p=0.000, r=0.65).4. Visible plaques were observed in70%(7/10) EPD, and distal branch artery embolization occurredin18.2%(2/11)cases without using EPD. Although the embolization disappeared after aspirationembolectomy and thrombolysis.Conclusion:1. Balloon prediliated can enlarge the vascular diameter which was helpful for thetransition of the Silverhawkcatheter but with no improvement to the therapeutic effect.2. Silverhawk atherectomy catheter can remove calcified plaques but with poor efficiency, and maycost more atherectomy time than those with no calcified lesions.3. Calcified lesions required more additional stenting than those of no calcified lesions.4. Silverhawk atherectomy time and vascular lesions length were positively correlated.5. EPD was usefull in reducing the incidence of distal embolization. |
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