Clinical Utility of the Rotational and Orbital Atherectomy System in the Endovascular Therapy of Severely Calcified Femoropopliteal Lesions

Abstract

Background: Endovascular therapy (EVT) for severely calcified femoropopliteal (FP) lesions in patients with peripheral artery disease (PAD) is challenging. This study evaluates the clinical utility of rotational atherectomy and orbital atherectomy in EVT for such lesions.

Methods and Results: This single-center retrospective study enrolled 62 consecutive patients with symptomatic PAD (71.0% male; median age 76 years; diabetes 71.0%; hemodialysis 30.6%; chronic limb-threatening ischemia 27.4%) due to severely calcified FP lesions (chronic total occlusion 32.3%; average lesion length 150 mm; Peripheral Arterial Calcium Scoring System classification: grade 1, 6.5%; grade 2, 12.9%; grade 3, 22.6%; and grade 4, 54.8%) who underwent EVT with atherectomy systems. The luminal gain was evaluated using angiography and intravascular ultrasound (IVUS). Quantitative vascular analysis showed stenosis diameters of 86.6% (pretreatment), 48.4% (after atherectomy), and 25.5% (after adjunctive balloon angioplasty). IVUS indicated the minimum lumen area increased from 2.0 mm²to 8.1 mm²after atherectomy and 17.8 mm²after angioplasty (P<0.001). Superficial calcium arcs decreased from 195.9° (141.6, 360) to 158.7° (119.9, 211.2; P<0.001). Procedural success was achieved in all patients. Distal embolization occurred in 7 patients. No major adverse events occurred within 30 days.

Conclusions: Atherectomy systems significantly increased lumen dimensions in severely calcified FP lesions by removing superficial calcium without increasing the risk of major complications. However, a notable incidence of distal embolism remains unavoidable.