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Direktionale Atherektomie mit antirestenotischer Therapie für die femoropopliteale periphere arterielle Verschlusskrankheit

Directional atherectomy with anti-restenotic therapy for femoropopliteal peripheral arterial occlusive disease

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Zusammenfassung

Die Einführung der medikamentenbeschichteten Ballons („drug-coated balloons“, DCB) stellte einen Fortschritt für die Behandlung der femoropoplitealen Verschlusskrankheit dar und behob einige Limitationen des endovaskulären Verfahrens. Die DCB-Angioplastie als alleinstehende Therapie ist jedoch mit einem erhöhten Risiko für flusslimitierende Dissektionen sowie mit unbefriedigenden Ergebnissen bei stark kalzifizierten Läsionen verbunden. Die Gefäßvorbereitung mittels direktionaler Atherektomie im Sinne der Abtragung des kalzifizierten Anteils der Plaque vor der lokalen Abgabe von Paclitaxel mittels Ballonangioplastie könnte die Ergebnisse der DCBs verbessern. In diesem Beitrag wird die Anwendung der direktionalen Atherektomie in Kombination mit einer antirestenotischen Therapie („directional atherectomy with anti-restenotic therapy“, DAART) für die Behandlung der femoropoplitealen Gefäße zusammengefasst.

Abstract

The introduction of drug-coated balloons (DCB) led to a paradigm shift in the treatment of femoropopliteal arterial occlusive disease and solved many limitations of endovascular therapy; however, the high risk for post-angioplasty flow-limiting dissection and the poor outcomes of paclitaxel-coated balloons in severe calcified lesions limit the performance of DCB angioplasty alone. The preparation of the arterial wall with directional atherectomy in the sense of debulking of the calcified parts of the placque prior to the local administration of paclitaxel with DCB angioplasty might improve the outcome of drug elution. The aim of this article is to present the use of directional atherectomy with anti-restenotic therapy (DAART) for the treatment of femoropopliteal arterial disease.

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Authors and Affiliations

  1. Zentrum für Gefäßchirurgie, St. Franziskus Hospital Münster GmbH, Münster, Deutschland

    K. Stavroulakis, Ö. Sensebat, G. Torsello, A. Schwindt & T. Bisdas

  2. Universitätsklinikum Münster, Waldeyerstraße 30, 48149, Münster, Deutschland

    K. Stavroulakis, Ö. Sensebat, G. Torsello, A. Schwindt & T. Bisdas

Authors
  1. K. Stavroulakis
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  2. Ö. Sensebat
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  3. G. Torsello
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  4. A. Schwindt
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Correspondence to K. Stavroulakis.

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Interessenkonflikt

K. Stavroulakis hat Honorare von Medtronic und Boston Scientific erhalten. A. Schwindt hat Honorare von Medtronic erhalten und ist Mitglied des Beirats der Avinger Inc. T. Bisdas ist Berater für Boston Scientific, Medtronic, BARD und COOK Medical. Ö. Sensebat und G. Torsello geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Stavroulakis, K., Sensebat, Ö., Torsello, G. et al. Direktionale Atherektomie mit antirestenotischer Therapie für die femoropopliteale periphere arterielle Verschlusskrankheit. Gefässchirurgie 23, 90–96 (2018). https://doi.org/10.1007/s00772-018-0366-z

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