Effective Endovascular Treatment of Calcified Femoropopliteal Disease With Directional Atherectomy and Distal Embolic Protection: Final Results of the DEFINITIVE Ca++ Trial

Objectives: The purpose of the DEFINITIVE Ca++ study was to evaluate the safety and effectiveness of directional atherectomy and distal embolic protection, used together to treat moderate to severely calcified femoropopliteal lesions. Background: Despite advances in endovascular treatment modalities, treatment of calcified lesions remains a challenge. Methods: A total of 133 subjects with 168 moderate to severely calcified lesions were enrolled. Lesions were treated with directional atherectomy devices, coupled with distal embolic protection. Results: The 30-day freedom from MAE rate was 93.1%. Per angiographic core laboratory assessment, the primary effectiveness endpoint (<= 50% residual diameter stenosis) was achieved in 92.0% (lower confidence bound of 87.6%) of lesions. By core lab analysis, these results did not achieve the success criteria (90%) for the primary effectiveness objective. Per site assessment, the objective was met with the endpoint being achieved in 97.0% (lower confidence bound 93.8%). A mean residual diameter stenosis of 33.3% was achieved with the directional atherectomy device. This was further decreased to 24.1% with the use of adjunctive therapy. The proportion of asymptomatic subjects [ Rutherford Clinical Category (RCC)=0] increased from 0% at baseline to 52.3% at the 30-day follow-up visit. In total, 88.5% of subjects experienced an improvement of one or more Rutherford categories. Conclusions: The results of the DEFINITIVE Ca++ study demonstrate that the SilverHawk (TM) and TurboHawk (TM) atherectomy devices are safe and effective in the endovascular treatment of moderate to severely calcified lesions in the superficial femoral and/or popliteal arteries when used with the SpiderFX (TM) distal embolic protection device. (C) 2014 Wiley Periodicals, Inc.