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DOI: 10.1055/s-0031-1281634
© Georg Thieme Verlag KG Stuttgart · New York
Behandlung von Instent-Reokklusionen der femoropoplitealen Arterien mit einem mechanischen Rotationskatheter
Treatment of In-Stent Reocclusions of Femoropopliteal Arteries with Mechanical Rotational CathetersPublikationsverlauf
eingereicht: 17.1.2011
angenommen: 2.7.2011
Publikationsdatum:
05. September 2011 (online)
Zusammenfassung
Ziel: Hauptproblem der Behandlung von Gefäßstenosen mittels perkutaner transluminaler Angioplastie (PTA) und Stentimplantion ist die relativ hohe Restenoserate. Ziel dieser prospektiven Single-Center-Studie war die Evaluierung eines mechanischen Rotationskatheters (Straub Rotarex®) hinsichtlich der Sicherheit und Effektivität bei der Behandlung von Instent-Reokklusionen. Material und Methoden: Es wurden 78 Patienten, mittleres Alter 64,2 ± 8,3 Jahre (42 – 85), mittels des Rotarex®-Katheters behandelt. Alle Patienten hatten subakute oder chronische Instent-Reokklusionen der Femoropoplitealarterien. Die präinterventionelle Rutherford-Klassifkation war im Mittel 3,36 (2 – 5). Die mittlere Läsionslänge betrug 14,7 cm (6 – 30 cm). Der Knöchel-Arm-Index (KAI) wurde prä- und postinterventionell sowie nach 12 Monaten bestimmt. Es erfolgte zusätzlich eine Verlaufskontrolle mittels farbkodierter Duplex-Sonografie. Ergebnisse: Die technische Erfolgsrate betrug 97,4 % (76 / 78). Bei 52 / 76 Patienten (68,4 %) wurde eine zusätzliche Ballondilatation durchgeführt, bei 8 / 76 (10,5 %) Patienten war eine weitere Stentimplantation notwendig. Klinisch zeigte sich eine Steigerung des Knöchel-Arm-Index von 0,61 ± 0,17 auf postinterventionell 0,85 ± 0,15 und nach 12 Monaten 0,78 ± 0,16 sowie eine Reduktion des Rutherford-Stadiums auf 1,9 (1 – 4). Während des Nachbeobachtungszeitraums traten 14 (18,4 %) Restenosen auf. Es gab periinterventionell 2 Dissektionen, welche erfolgreich mittels PTA behandelt wurden. Es wurden keine distalen Embolisationen beobachtet. Während der gesamten Studiendauer gab es keine Amputationen oder Todesfälle. Schlussfolgerung: Die Rekanalisation von Instent-Reokklusionen der femoropoplitealen Arterien mittels des Rotarex®-Systems ist sicher und effektiv. Die geringe Restenoserate nach 12 Monaten erscheint vielversprechend.
Abstract
Purpose: The main problem with the treatment of arterial stenoses by percutaneous transluminal angioplasty (PTA) or stent implantation is the relatively high restenosis rate. The objective of this prospective single-center study was to evaluate a mechanical rotational catheter (Straub Rotarex®) for its safety and efficacy in the treatment of in-stent reocclusions. Materials and Methods: 78 patients with a mean age of 64.2 ± 8.3 years (42 – 85) were treated by means of the Rotarex® catheter. All patients had in-stent reocclusions of the femoropopliteal arteries. The preinterventional Rutherford stage was on average 3.36 (2 – 5). The mean lesion length was 14.7 cm (6 – 30 cm). The ankle-brachial index (ABI) was determined prior to and after the intervention, as well as after 12 months. An additional follow-up was performed using color-coded duplex sonography. Results: The technical success rate was 97.4 % (76 / 78). In 52 / 76 patients (68.4 %), adjunctive balloon dilation was performed, and 8 / 76 (10.5 %) patients required a stent implantation. Clinically, there was an increase in the ankle-brachial index from 0.61 ± 0.17 to 0.85 ± 0.15 post-interventionally. After 12 months, it was 0.78 ± 0.16, and the average Rutherford stage fell to 1.65 (1 – 3). During the follow-up observation period, there were 14 (18.4 %) restenoses. Two dissections after Rotarex were recorded as peri-interventional complications. No distal embolizations were observed. There were no amputations or deaths during the entire period of the study. Conclusion: The recanalization of in-stent reocclusions of femoropopliteal arteries using the Rotarex® system is safe and effective. The low rate of restenosis at 12 months appears to be promising.
Key words
angioplasty - arteries - stents - obstruction/occlusion
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Dr. Christian Wissgott
Institut für Diagnostische und Interventionelle Radiologie/Neuroradiologie, Westküstenklinikum Heide – Akademisches Lehrkrankenhaus der Universitäten Kiel, Lübeck und Hamburg
Esmarchstr. 50
25746 Heide
Telefon: ++ 49/4 81/7 85 24 01
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eMail: cwissgott@gmx.de