Limb Salvage Outcomes Following Therapy Using OCT Guided Directional Atherectomy in Popliteal and Tibial Vessels
Alison Kinning, MD, Patrick E. Muck, MD, Matthew Recht, MD, Brian Kuhn, MD, Aaron Kulwicki, MD.
Good Samaritan Hospital, Cincinnati, OH, USA.
OBJECTIVES: To evaluate the safety and efficacy of OCT image-guided directional atherectomy in lower extremity interventions on patients with critical limb ischemia (CLI).
METHODS: OCT image-guided directional atherectomy was FDA approved in 2016. This retrospective study evaluated patients with CLI undergoing real time image-guided directional atherectomy of popliteal and/or tibial arteries from January 2016 through September 2017. Endpoints measured were periprocedural complications, freedom from major amputation, and target lesion revascularization (TLR).
RESULTS: 63 patients underwent OCT-guided atherectomy during the study timeframe. Of this cohort, 9 patients (10 limbs) with CLI underwent popliteal or tibial image-guided directional atherectomy. The mean follow up was 9.9 months (range 3-16 months). Twelve image-guided atherectomies (3 popliteal, 1 tibioperoneal trunk, 4 anterior tibial, 1 peroneal, 3 posterior tibial) were performed on 9 patients and 10 limbs. No periprocedural complications (distal embolization, dissection requiring a stent, or perforations) were observed. One patient required a major amputation (BKA) at 13 months. Of the remaining patients, zero TLRs were reported.
CONCLUSIONS: Fluoroscopy-guided atherectomy has been used for more than a decade on patients with critical limb ischemia. This retrospective analysis is the first attempt to measure outcomes when performing OCT image-guided directional atherectomy in CLI patients. We hypothesize that image guidance enables a superior safety profile with accurate plaque removal and limited or no vessel wall disruption as well as reduces inflammation and associated restenosis factors. We demonstrate that OCT-guided directional atherectomy is safe and effective for treating patients with CLI. Further work is required to confirm the trend towards long term patency and freedom from TLR.
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