Int J Angiol
DOI: 10.1055/s-0036-1587694
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ubiquitous Nature of Distal Athero/Thromboembolic Events during Lower Extremity Atherectomy Procedures Involving the Superficial Femoral Artery

Najam Wasty
1   Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey
,
M. Z. Khakwani
1   Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey
,
Spas Kotev
1   Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey
,
Catalin Boiangiu
1   Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey
,
Omar Hasan
1   Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey
,
Manjusha Anna
1   Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey
,
Rajiv Tayal
1   Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey
,
Khalil Kaid
1   Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey
,
Gail Baker
1   Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey
,
Marc Cohen
1   Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey
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Publikationsverlauf

Publikationsdatum:
05. September 2016 (online)

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Abstract

This study aims to evaluate occurrence, size, composition, and clinical significance of embolized debris during superficial femoral artery atherectomy using all commercially available atherectomy devices.

Distal athero/thromboembolic events (DATE) are a universal phenomenon in lower extremity atherectomy procedures (LEAPs) due to the sheer volume of atheroma and the thrombus burden in peripheral arterial disease. Some of these events can be clinically significant.

We prospectively gathered clinical and histopathological data on all commercially available atherectomy devices by using embolic protection devices (EPD) in every case. After intervention, the contents of EPD were examined both microscopically and macroscopically.

Data from 59 consecutive patients undergoing LEAP were analyzed. DATE occurred 100% of the time. The composition of particulate debris varied with the device used. Grossly visible agglomerated debris was captured by the filter in the majority of patients 54/59 (91.5%). Clinically significant debris, defined by the Preventing Lower Extremity Distal Embolization Using Embolic Filter Protection registry as particle diameter > 0.2 cm, was found in 33/59 (56%) patients. The size of captured debris particles ranged from 0.1 to 2.4 mm.

While DATE occurred in all patients, clinically significant DATE occurred in 56% patients undergoing LEAP regardless of the atherectomy device. In spite of a large fraction of the clinically significant debris occurring on our routine dual antiplatelet regimen, no patient suffered an amputation. Although DATE was prevented by the use of EPD in all 59 cases, more data are needed to determine whether the use of EPD translates into a long-term clinical benefit. Use of EPD and optimal thromboprophylaxis should be considered in patients, especially in the setting of compromised distal runoff.