[Other techniques of arterial recanalization]

Abstract

During the last few years several new instruments have been added to the armentarium of endovascular procedures. They are aimed at destroying atheromatous plaques and recalibrating the arteries. The plaque destruction techniques include atherectomy which may be directional (as with Simpson's Atherocath) and applicable only to very proximal vascular segments, or rotational, pulverizing the plaques with a bur. In this category are the flexible Auth's rotablator and Stack's transluminal extraction catheter (TEC) where planning is combined with extraction. To traverse complete occlusions, Kaltenbach's rotating guide increases the success rate, but its use must always be completed by conventional angioplasty. Vascular recalibration can be achieved by stents or heating balloons. Numerous types of stent are now available. The best known are the Medivent stent which is self-expansive and stents with expanding balloons, such as the Palmaz Schatz stent or the radio-opaque Wiktor stent made of tantalum. These stents require an important anticoagulant therapy. These technique have widened the limits of angioplasty by tackling stenoses that have long been regarded as inaccessible. They have also made it possible to treat a number of acute occlusions. On the other hand, none of them has yet proved effective in the prevention of restenosis.