The Hemodynamic Effects of Directional Atherectomy on Translesional Pressure Gradients in the Lower Extremity

Background
There are limited data regarding the impact of directional atherectomy on translesional hemodynamics in infrainguinal peripheral arterial lesions. We examined the effect of directional atherectomy on both resting and hyperemic distal to proximal mean pressures (Pd/Pa) and translesional systolic pressure gradients (TLPG).

Methods
Patients with CLI or claudication and with lesions of the superficial femoral (SFA)/popliteal, or tibial vessels were eligible. The Navvus catheter (ACIST Medical) was used to measure the distal to proximal (sheath tip) mean pressures (Pd/Pa) and the peak translesional systolic pressure gradients (TLPG) before and after directional atherectomy and with and without hyperemia with 100 mcg adenosine.

Results
15 subjects were enrolled with a mean age 59 ±12 years, 8 male, 14 with diabetes, 10 with claudication, and 9 with CKD. Lesions treated included 11 fem-pop and 4 tibial vessels. There was a significant improvement in Pd/Pa after treatment with atherectomy both with and without hyperemia (0.77±0.13 to 0.86± 0.10, p<0.001) and (0.85±0.10 to 0.92±0.06, p=0.001), respectively. There was also a statistically significant reduction in TLPG after treatment with atherectomy both with and without hyperemia (41.8±23.4 to 25.9±16.4, p=0.01) and (34.7±23.4 to 19.5±12.6, p=0.004), respectively.

Conclusions
We demonstrate an acute hemodynamic benefit following directional atherectomy. There was a significant decline in TLPG and an increase in Pd/Pa after directional atherectomy. Further data are needed to determine if these changes in hemodynamics after intervention translate into improved clinical outcomes.