-
Expert Review of Cardiovascular Therapy Apr 2015Critical limb ischemia (CLI) represents an advanced disease state of peripheral arterial disease. It manifests as lower extremity ischemic rest pain or ischemic skin... (Review)
Review
Critical limb ischemia (CLI) represents an advanced disease state of peripheral arterial disease. It manifests as lower extremity ischemic rest pain or ischemic skin lesions leading to ulceration or gangrene. Patients with CLI often have multiple medical comorbidities and a 1-year mortality rate of 25% and a 1-year amputation rate of 25%. Historically, bypass surgery with autogenous veins for flow restoration has been the first-line therapy for CLI. However, advances in endovascular techniques and device technology have changed the treatment paradigm. Catheter-based technologies are rapidly evolving at a rate that is outpacing large-scale studies evaluating relevant clinical outcomes. Patients with CLI require a multidisciplinary management approach centered on aggressive medical therapies, wound care and prompt revascularization, with an emphasis on limb salvage. This review summarizes the contemporary endovascular therapies including balloon angioplasty, atherectomy and bare-metal stenting. In addition, we review emerging technologies, such as drug-eluting stents, drug-coated balloons and chronic total occlusion recanalization devices.
Topics: Amputation, Surgical; Angioplasty; Atherectomy; Drug-Eluting Stents; Endovascular Procedures; Humans; Ischemia; Limb Salvage; Peripheral Arterial Disease; Treatment Outcome
PubMed: 25728744
DOI: 10.1586/14779072.2015.1019472 -
Surgical Technology International May 2015Infrapopliteal arterial disease is a challenging problem to treat. A shift toward an endovascular treatment approach over surgical bypass has occurred over recent years.... (Review)
Review
Infrapopliteal arterial disease is a challenging problem to treat. A shift toward an endovascular treatment approach over surgical bypass has occurred over recent years. Although current standard percutaneous transluminal balloon and bare metal stents are employed, their durability and outcomes are questionable. A number of endovascular advancements in the treatment of infrapopliteal (IP) arterial disease have recently been made. We review the recent literature for new atherectomy, stent, and balloon technologies.
Topics: Angioplasty, Balloon; Atherectomy; Humans; Peripheral Arterial Disease; Popliteal Artery; Stents
PubMed: 26055012
DOI: No ID Found -
Cardiology Journal 2019Bifurcating coronary lesions are a very common challenge in interventional cardiology because of the technical complexity in their treatment, the risk of side branch... (Review)
Review
Bifurcating coronary lesions are a very common challenge in interventional cardiology because of the technical complexity in their treatment, the risk of side branch occlusion and an overall worse outcome when compared to non-bifurcating lesions. The presence of calcifications represents further complexity due to the difficulty in device delivery and stent expansion as well as enhanced risk of side branch occlusion. Rotational and orbital atherectomy, scoring and cutting balloons, coronary lithoplasty are available tools which have been introduced over the last three decades to overcome such issue. Nevertheless, their application in different contexts of bifurcations presents specific caveats and the studies directed at comparing such techniques have never been expressly oriented in the subset of the bifurcating lesion. In this paper, we review these devices and their usefulness in bifurcations by analyzing consistent data from clinical trials, and we propose a practical algorithm for the treatment of severely calcified bifurcating lesions according to their anatomical features.
Topics: Atherectomy, Coronary; Coronary Artery Disease; Humans; Lithotripsy; Percutaneous Coronary Intervention; Severity of Illness Index; Stents; Treatment Outcome; Vascular Calcification
PubMed: 31565792
DOI: 10.5603/CJ.a2019.0094 -
The American Journal of Cardiology Jul 2024
Topics: Humans; Atherectomy, Coronary; Coronary Artery Disease; Postoperative Complications
PubMed: 38761963
DOI: 10.1016/j.amjcard.2024.05.011 -
Revista Portuguesa de Cardiologia :... Apr 2015Percutaneous coronary intervention is currently the most common form of revascularization for symptomatic coronary artery disease. In elderly, diabetic and renal... (Review)
Review
Percutaneous coronary intervention is currently the most common form of revascularization for symptomatic coronary artery disease. In elderly, diabetic and renal patients, there is an increased prevalence of calcified coronary disease. Rotational atherectomy (RA) can be useful in the treatment of these lesions. Plaque removal was initially proposed as an alternative to balloon angioplasty, hence RA required high-velocity protocols with large-sized burrs (over 2.0 mm). With a high incidence of acute complications and disappointing restenosis rates, the use of RA dwindled. However, the advent of drug-eluting stents, which significantly decreased the rate of restenosis, led to the repositioning of RA as an adjunctive technique in the preparation of densely calcified lesions, improving stent delivery and expansion. In recent years, a better understanding of the mechanism of action of RA has changed it from a plaque debulking to a compliance modifying technique. As a result, RA has become less aggressive, using smaller size burrs and lower rotational speeds. This conservative approach has improved immediate results, with increased safety and better long-term outcomes. In this review paper, the technique of RA is explained in the light of current knowledge.
Topics: Atherectomy, Coronary; Coronary Artery Disease; Equipment Design; Humans
PubMed: 25843308
DOI: 10.1016/j.repc.2014.11.011 -
The Journal of Cardiovascular Surgery Feb 2015In the femoropopliteal segment, endovascular revascularization techniques have gained the role as a first line treatment strategy. Nitinol stent placement has improved... (Review)
Review
In the femoropopliteal segment, endovascular revascularization techniques have gained the role as a first line treatment strategy. Nitinol stent placement has improved the short- and mid-term primary patency rates in most lesion types and is therefore widely applied. Stenting has several shortcomings as in-stent restenosis, stent fractures and foreign material being left behind in the vessel. The concept of atherectomy is plaque debulking. This results in a potential reduction of inflation pressure requirements in angioplasty. Stent placement and consecutive in-stent restenosis may be avoided. In this non systematic literature review, the performance of different atherectomy techniques, such as direct atherectomy, orbital atherectomy, laser debulking and rotational atherectomy in the treatment of complex femoropopliteal lesions, including long lesions, moderately to heavily calcified lesions as well as occlusions and in-stent restenosis, has been analyzed.
Topics: Alloys; Atherectomy; Constriction, Pathologic; Equipment Failure; Femoral Artery; Graft Occlusion, Vascular; Humans; Inguinal Canal; Lasers, Excimer; Peripheral Vascular Diseases; Popliteal Artery; Severity of Illness Index; Stents; Treatment Outcome; Vascular Calcification; Vascular Patency
PubMed: 25399550
DOI: No ID Found -
Cardiovascular Revascularization... Jul 2019
Topics: Atherectomy; Atherectomy, Coronary; Humans; Vascular Calcification
PubMed: 31153848
DOI: 10.1016/j.carrev.2019.05.005 -
Catheterization and Cardiovascular... Oct 2015Rotational atherectomy is effective and safe in selected complex calcified lesions. Despite an older population with more comorbidities, rotational atherectomy is not...
Rotational atherectomy is effective and safe in selected complex calcified lesions. Despite an older population with more comorbidities, rotational atherectomy is not associated with worse clinical outcomes. Coronary interventionalists need to be well-trained in both the use of atherectomy techniques as well as how to manage potential complications.
Topics: Atherectomy, Coronary; Coronary Artery Disease; Female; Hospital Mortality; Humans; Male; Myocardial Infarction; Registries
PubMed: 26386232
DOI: 10.1002/ccd.26226 -
Journal of the American Heart... Nov 2022Background Atherectomy has become the fastest growing catheter-based peripheral vascular intervention performed in the United States, and overuse has been linked to...
Background Atherectomy has become the fastest growing catheter-based peripheral vascular intervention performed in the United States, and overuse has been linked to increased reimbursement, but the patterns of use have not been well characterized. Methods and Results We used Blue Cross Blue Shield of Michigan Preferred Provider Organization and Medicare fee-for-service professional claims data from the Michigan Value Collaborative for patients undergoing office-based laboratory atherectomy in 2019 to calculate provider-specific rates of atherectomy use, reimbursement, number of vessels treated, and number of atherectomies per patient. We also calculated the rate that each provider converted a new patient visit to an endovascular procedure within 90 days. Correlations between parameters were assessed with simple linear regression. Providers completing ≥20 office-based laboratory atherectomies and ≥20 new patient evaluations during the study period were included. A total of 59 providers performing 4060 office-based laboratory atherectomies were included. Median professional reimbursement per procedure was $4671.56 (interquartile range [IQR], $2403.09-$7723.19) from Blue Cross Blue Shield of Michigan and $14 854.49 (IQR, $9414.80-$18 816.33) from Medicare, whereas total professional reimbursement from both payers ranged from $2452 to $6 880 402 per year. Median 90-day conversion rate was 5.0% (IQR, 2.5%-10.0%), whereas the median provider-level average number of vessels treated per patient was 1.20 (IQR, 1.13-1.31) and the median provider-level average number of treatments per patient was 1.38 (IQR, 1.26-1.63). Total annual reimbursement for each provider was directly correlated with new patient-procedure conversion rate (=0.47; <0.001), mean number of vessels treated per patient (=0.31; <0.001), and mean number of treatments per patient (=0.33; <0.001). Conclusions A minority of providers perform most procedures and are reimbursed substantially more per procedure compared with most providers. Procedural conversion rate, number of vessels, and number of treatments per patient represent potential policy levers to curb overuse.
Topics: Humans; Aged; United States; Medicare; Atherectomy; Fee-for-Service Plans; Endovascular Procedures; Michigan
PubMed: 36300666
DOI: 10.1161/JAHA.121.023356 -
The Journal of Invasive Cardiology Apr 2017Peripheral arterial disease (PAD) is a clinical manifestation of systemic atherosclerosis and is associated with significant morbidity and mortality. The physiological... (Review)
Review
Peripheral arterial disease (PAD) is a clinical manifestation of systemic atherosclerosis and is associated with significant morbidity and mortality. The physiological force and shear stress from angioplasty and stenting have made PAD treatment challenging. Atherectomy devices have continued to emerge as a major therapy in the management of peripheral vascular disease. This article presents a review of the current literature for the atherectomy devices used in PAD.
Topics: Atherectomy; Humans; Peripheral Arterial Disease; Treatment Outcome
PubMed: 28368845
DOI: No ID Found