Our Experience with Catheter-based Plaque Excision for Symptomatic Peripheral Vascular Disease: Is it Ready for Primetime?

Objectives: Evaluate catheter-based plaque excision as a modality to treat either disabling claudication or critical limb ischemia.
Methods: Retrospective review of 39 patients who underwent catheter-based plaque excision between October 2003 and June 2006. Data include: risk factors for atherosclerosis, procedural details (devices used, number of passes, vessels treated, residual disease) and complications. The pre and post-procedural clinical status was compared based on grade and category of chronic limb ischemia, non-invasive arterial pressure measurements, signs and symptoms of arterial improvement /compromise and healing of ulceration. Adjunctive procedures were noted. Endpoints included clinical status change, minor and major amputations and additional revascularization procedures evaluated at 30-days, 3 and 6 months.
Results: Of 39 patients 16 had disabling claudication and 23 had critical limb ischemia. Mean follow-up was 238 days (66 - 592), number of vessels treated per limb was 1.74 (1 - 4) and number of passes was 9.46 (2 - 24 per limb). In 79.5% of patients, residual luminal disease was less than 20%. Two distal embolizations were noted. The ankle-brachial index improved from 0.47 ± 0.28 to 0.70 ± 0.31 (p=0.00018). Improvement of clinical grade and category was significant for claudicants. Post-procedurally, arterial bypass or angioplasty involving the initial target lesion was required in 13%(5/39) and 21% (8/39) respectively. Major amputation was performed in 15%(6/39). Ulcer resolution occurred in 35% (7/20) of patients with tissue loss.
Conclusion: Catheter-based plaque excision provides a viable option for patients in whom open revascularization is limited by increased co-morbid conditions or limited conduit.