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A randomized trial of transcutaneous extraction atherectomy in femoral arteries: Intravascular ultrasound observations
Author(s) -
Nakamura Shigeru,
Conroy Robert M.,
Gordon Ian L.,
Deutsch LarryStuart,
Maheswaran Bavani,
Antone Curtis S.,
Tobis Jonathan M.
Publication year - 1995
Publication title -
journal of clinical ultrasound
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.272
H-Index - 61
eISSN - 1097-0096
pISSN - 0091-2751
DOI - 10.1002/jcu.1870230802
Subject(s) - medicine , atherectomy , balloon , intravascular ultrasound , ultrasound , lumen (anatomy) , femoral artery , atheroma , radiology , balloon catheter , catheter , occlusion , surgery , nuclear medicine , restenosis , stent , cardiology
Objectives . The purpose of this study was to test the hypothesis that in occlusions of the superficial femoral artery, removal of atherosclerotic plaque would result in a higher long‐term patency rate compared to balloon dilatation alone. A secondary hypothesis was that long term patency would be proportional to the amount of plaque removed. Methods . A randomized controlled study of patients with occluded superficial femoral arteries was performed comparing balloon dilatation alone versus a 2.7 mm or a larger (4.0 mm or 4.7 mm) transcutaneous extraction catheter (TEC) atherectomy device followed by balloon dilatation. The effect of these devices on plaque area was assessed directly by intravascular ultrasound imaging. Results . The mean occlusion length was 19.4 cm ± 11.7 cm. The mean lumen area increased from 4.7 mm 2 to 15.1 mm 2 , primarily due to balloon dilatation, but the mean atheroma area of 19.8 mm 2 did not change with either size of TEC device. Although the initial procedure success rate was high (79%), the 6 month patency was only 45%. There was no difference in 6 month patency between the 3 groups. Conclusions . The data indicate that the TEC atherectomy devices do not remove a significant amount of atherosclerotic plaque in occluded superficial femoral arteries. The 6 month patency is no different with these atherectomy devices than with balloon dilatation alone. The larger (4.0 mm or 4.7 mm) TEC device does not remove any more tissue than the smaller (2.7 mm) device. The use of intravascular ultrasound to quantitate the effects of this atherectomy device provides important insights into the mechanism of action and lack of efficacy of the TEC atherectomy catheter. © 1995 John Wiley & Sons, Inc.