Percutaneous Rotational Mechanical Atherectomy Plus Thrombectomy Using Rotarex S Device in Patients With Acute and Subacute Lower Limb Ischemia: A Review of Safety, Efficacy, and Outcomes.
Percutaneous Rotational Mechanical Atherectomy Plus Thrombectomy Using Rotarex S Device in Patients With Acute and Subacute Lower Limb Ischemia: A Review of Safety, Efficacy, and Outcomes.
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DOI：
10.3389/fcvm.2020.557420
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发表时间：
2020
影响因子：
3.6
通讯作者：
Chevallier O
中科院分区：
文献类型：
--
作者：
Loffroy R;Falvo N;Galland C;Fréchier L;Ledan F;Midulla M;Chevallier O
急性和亚急性下肢缺血与截肢的高风险和潜在的严重危及生命的并发症相关。尽管缺乏明确的治疗建议，但外科治疗（如血栓切除术或旁路和/或导管导向溶栓（CDT））已成为急性和亚急性肢体缺血的一线治疗方法，但每种治疗均可能导致显著的发病率和死亡率。这种情况需要快速恢复适当的流量，以防止肢体丧失和其他并发症。经皮机械斑块旋切术加血栓切除术（MATH）是一种快速再通含血栓病变（无论血栓年龄）的微创方法。事实上，许多慢性患者可表现为严重肢体缺血，由潜在的动脉粥样硬化疾病引发的含血栓闭塞性病变。与手术和CDT相比，MATH具有多种优势，侵入性更低，再通更快，可以立即治疗潜在病变，出血并发症发生率更低，无需入住重症监护室。目前，提供了几种机械血栓切除术器械作为替代疗法，可分为纯旋转MATH系统和流变血栓切除术器械。目前市场上唯一可用的纯旋转MATH器械是Rotarex S器械。我们的目的是审查关于使用Rotarex S导管进行MATH治疗下肢急性和亚急性含血栓动脉病变的安全性、有效性和结局的当代临床数据。还将讨论Rotarex S MATH治疗的未来前景及其常规使用的成本效益。
Acute and subacute ischemia of lower limbs is associated with high risk of amputation and potential severe life-threatening complications. Despite a lack of clear therapeutic recommendations, surgical treatments such as thrombectomy or bypass and/or catheter-directed thrombolysis (CDT) have been first-line procedures in both acute and subacute limb ischemia, but each therapy may lead to significant morbidity and mortality. Such situations demand fast restoration of appropriate flow to preclude limb loss and other complications. Percutaneous mechanical atherectomy plus thrombectomy (MATH) represents a minimally invasive approach for quickly recanalizing thrombus-containing lesions whatever the age of thrombus. Indeed, many chronic patients can present with critical limb ischemia, with thrombus-containing occlusive lesions triggered by underlying atherosclerotic disease. MATH offers various advantages over surgery and CDT, with lower invasiveness, faster recanalization, and the possibility to immediately treat the underlying lesions, with a lower rate of bleeding complications and no need for intensive care unit stay. Currently, several mechanical thrombectomy devices are offered as an alternative therapy and can be divided into pure rotational MATH systems and rheolytic thrombectomy devices. The only pure rotational MATH device currently available on the market is the Rotarex S device. We aimed to review contemporary clinical data regarding the safety, efficacy, and outcomes of MATH therapy using Rotarex S catheter in acute and subacute thrombus-containing arterial lesions of lower limbs. Future perspectives of Rotarex S MATH treatment and cost-effectiveness of its routine use will be also discussed.