Vaskulárna medicína 4/2011

Mechanical thrombectomy using the Rotarex catheter in treatment of acute and subacute occlusions of peripheral arteries

The aim of this study was to evaluate the efficacy of mechanical thrombectomy using the Rotarex catheter in the treatment of peripheral arterial acute and subacute occlusions and to assess longer-term results. The Rotarex catheter (Straub Medical, Switzerland) was used for percutaneous mechanical thrombectomy. This is a 6F or 8F polyurethane catheter, which contains a steel spiral powered by an electric motor and rotating at a speed of 40 000 rpm. The catheter tip is connected to the spiral. The rotating spiral produces a continuous vacuum and the thromboembolic material „drilled” by the tip is drawn into the catheter, where it is fragmented and transported via the spiral to the collecting bag. By means of this system we have conducted 40 interventions in 38 patients (20 men, 18 women, average age of 73 ± 11 (44 – 92 years) in peripheral arteries. The mean occlusion length was 12 ± 9 cm (2 – 37 cm); the average duration of symptoms was 27 ± 35 days (2 – 180 days), with median value of 14 days. Thrombectomy as the only procedure was sufficient in 11 interventions (27.5 %); a recanalization using Rotarex was completed with PTA in 19 procedures (47.5 %) and with stent implantation in 10 procedures (25 %). Angiographic success was achieved in 37 interventions (92.5 %). The most frequent transitory complication was embolization to the calf arteries (10 %). With the exception of 1 case it was resolved during the session. Subsequent thrombolysis was administered after 3 procedures (7.5 %). In 1 case (2.5 %) there was a minor perforation of the peroneal artery. Six-month post-intervention follow-up is available for 32 patients. Patency without significant restenosis was preserved in 67 %. After 12 months, 12 patients are still followed and 67 % of intervened segments remained patent without significant restenosis. The Rotarex system enables fast and efficient treatment of peripheral arterial acute and subacute occlusions although a combination with other percutaneous procedures is often necessary. Middle-term results are also acceptable because of seriousness of the clinical symptomatology – in most cases the limb was threatened.

Keywords: acute and subacute occlusions of peripheral arteries, thrombectomy using Rotarex