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EuroIntervention : Journal of EuroPCR... Dec 2023There is a paucity of real-world data on the in-hospital (IH) and post-discharge outcomes in patients undergoing lower extremity peripheral vascular intervention (PVI)...
BACKGROUND
There is a paucity of real-world data on the in-hospital (IH) and post-discharge outcomes in patients undergoing lower extremity peripheral vascular intervention (PVI) with adjunctive atherectomy.
AIMS
In this retrospective, registry-based study, we evaluated IH and post-discharge outcomes among patients undergoing PVI, treated with or without atherectomy, in the National Cardiovascular Data Registry PVI Registry.
METHODS
The IH composite endpoint included procedural complications, bleeding or thrombosis. The primary out-of-hospital endpoint was major amputation at 1 year. Secondary endpoints included repeat endovascular or surgical revascularisation and death. Multivariable regression was used to identify predictors of atherectomy use and its association with clinical endpoints.
RESULTS
A total of 30,847 patients underwent PVI from 2014 to 2019, including 10,971 (35.6%) treated with atherectomy. The unadjusted rate of the IH endpoint occurred in 524 (4.8%) of the procedures involving atherectomy and 1,041 (5.3%) of non-atherectomy procedures (p=0.07). After adjustment, the use of atherectomy was not associated with an increased risk of the combined IH endpoint (p=0.68). In the 6,889 (22.4%) patients with out-of-hospital data, atherectomy was associated with a reduced risk of amputation (adjusted hazard ratio [aHR] 0.67, 95% confidence interval [CI]: 0.51-0.85; p<0.01) and surgical revascularisation (aHR 0.63, 95% CI: 0.44-0.89; p=0.017), no difference in death rates (p=0.10), but an increased risk of endovascular revascularisation (aHR 1.21, 95% CI: 1.06-1.39; p<0.01) at 1 year.
CONCLUSIONS
The use of atherectomy during PVI is common and is not associated with an increase in IH adverse events. Longitudinally, patients treated with atherectomy undergo repeat endovascular reintervention more frequently but experience a reduced risk of amputation and surgical revascularisation.
Topics: Humans; Retrospective Studies; Peripheral Arterial Disease; Aftercare; Endovascular Procedures; Risk Factors; Treatment Outcome; Patient Discharge; Atherectomy; Lower Extremity
PubMed: 37750241
DOI: 10.4244/EIJ-D-23-00432 -
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 -
Cardiovascular Intervention and... Jul 2022Recently, the efficacy was demonstrated of the Diamondback 360® Coronary Orbital Atherectomy System (OAS) (Cardiovascular Systems, Inc., St. Paul, MN, USA) for... (Observational Study)
Observational Study
Recently, the efficacy was demonstrated of the Diamondback 360® Coronary Orbital Atherectomy System (OAS) (Cardiovascular Systems, Inc., St. Paul, MN, USA) for treating calcified coronary lesions in percutaneous coronary intervention (PCI). The safety and feasibility of OAS application through a 5-Fr guiding catheter (GC) which is less invasive and reduces access site complications were validated. This sequential, retrospective, observational study was conducted in a single center from September 2018 to May 2020. The primary endpoint was a successful PCI with the OAS. Secondary endpoints were major adverse complications related to PCI with the OAS, including coronary dissection, perforation, side branch loss, need for an unexpected cardiac assist device, access site complications, and major adverse cardiac and cerebrovascular events. 33 PCIs in 30 patients (mean age 72 ± 11 years; male, 83.3%) were surveyed. All PCIs were successfully completed with OAS application through a 5-Fr GC. Coronary perforation after the OAS procedure occurred in one case (3.0%). Severe coronary dissection occurred in three cases (9.1%), and procedural myocardial infarction in two cases (6.1%). Regarding PCIs performed with the 5-Fr GC, the OAS is a safe and feasible strategy for calcified plaque modification.
Topics: Aged; Aged, 80 and over; Atherectomy; Atherectomy, Coronary; Catheters; Coronary Angiography; Coronary Artery Disease; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Retrospective Studies; Severity of Illness Index; Time Factors; Treatment Outcome; Vascular Calcification
PubMed: 34554382
DOI: 10.1007/s12928-021-00813-3 -
Lancet (London, England)
Topics: Angioplasty, Balloon, Coronary; Atherectomy, Coronary; Humans
PubMed: 1361603
DOI: No ID Found -
The Journal of Cardiovascular Surgery Feb 2022Surgical endarterectomy represents the gold standard for the treatment of atherosclerotic lesions of the groin vessels. Endovascular treatment such as atherectomy with...
INTRODUCTION
Surgical endarterectomy represents the gold standard for the treatment of atherosclerotic lesions of the groin vessels. Endovascular treatment such as atherectomy with or without drug coated angioplasty (DCA) of the so called no stenting zones, i.e. inguinal and popliteal vessels, is gaining growing acceptance as alternative option to open surgery. This systematic review aims to scrutiny the current clinical evidence regarding atherectomy and DCA for the common artery (CFA).
EVIDENCE ACQUISITION
We conducted an exhaustive research in multiple platforms (Medline, PubMed, Cochrane, Google Scholar, Embase) on studies over atherectomy and angioplasty for inguinal atherosclerotic lesions published between 2000 and 2021. As search strategy we used a wide list of MeSH items, words, synonyms. Bibliographies of review articles were checked for further relating studies regarding atherectomy of CFA. A qualitative and quantitative data analysis was carried out.
EVIDENCE SYNTHESIS
Fifteen studies were included in the qualitative review. Not all studies were focused only on atherectomy of inguinal vessels, despite including such treatment. Hence, data regarding this treatment were not exhaustive. A fairly homogeneous data analysis was possible in 7 of 15 studies. The remaining 8 studies were qualitatively analyzed but not included in the statistical analysis. In all 7 included studies directional atherectomy and DCA under filter protection were carried out. In this subgroup, overall, 497 patients were treated with atherectomy. Sixty-eight percent of the patients were males. Rutherford class from 1-3 dominated against 4-6 (63% vs. 37%). Mean technical success rate was 96%, with a primary and secondary patency rate of 92% and 98% respectively at one year. Procedure related vascular complications ranged from 1% to 6%.
CONCLUSIONS
Current literature about atherectomy for inguinal arteries is scant, data are inhomogeneous and so are treatment modalities. Nevertheless, the results of this systematic review suggest that this endovascular strategy is feasible with good short and midterm results. Prospective trials with larger patient cohorts are necessary to confirm these preliminary results.
Topics: Animals; Atherectomy; Humans; Peripheral Arterial Disease; Plaque, Atherosclerotic; Treatment Outcome
PubMed: 35179336
DOI: 10.23736/S0021-9509.21.12172-X -
Cardiovascular Revascularization... Jul 2019
Topics: Atherectomy; Atherectomy, Coronary; Humans; Vascular Calcification
PubMed: 31153848
DOI: 10.1016/j.carrev.2019.05.005 -
Interventional Cardiology Clinics Apr 2017Atherectomy improves the acute procedural success of a procedure whether treating de novo or restenotic (including in-stent) disease. Intermediate follow-up results seem... (Review)
Review
Atherectomy improves the acute procedural success of a procedure whether treating de novo or restenotic (including in-stent) disease. Intermediate follow-up results seem to be in favor of atherectomy in delaying and reducing the need for repeat revascularization in patients with femoropopliteal in-stent restenosis. Recent data suggest that avoiding cutting into the external elastic lamina is an important factor in reducing restenosis. The interplay between directional atherectomy and drug-coated balloons is unclear.
Topics: Atherectomy; Endovascular Procedures; Femoral Artery; Humans; Peripheral Arterial Disease; Popliteal Artery
PubMed: 28257771
DOI: 10.1016/j.iccl.2016.12.007 -
Vascular Feb 2019To evaluate the effectiveness of directional atherectomy with a Phoenix atherectomy system in lower extremity peripheral arterial disease (LE-PAD).
OBJECTIVE
To evaluate the effectiveness of directional atherectomy with a Phoenix atherectomy system in lower extremity peripheral arterial disease (LE-PAD).
MATERIALS AND METHODS
A retrospective review of subjects who had undergone atherectomy for severe and occluded LE-PAD. Demographic data, procedural properties, and follow-up information were recorded. The technical, procedural and clinical successes were reported.
RESULTS
In total, 120 subjects were evaluated. The superficial femoral artery (SFA) group consisted of 64 subjects (53.3%), and the popliteal group consisted of 56 (46.7%) subjects. Groups did not differ in terms of age, gender, comorbid diseases and tobacco use. In both groups, four subjects (6.3% of SFA and 7.1% of the popliteal group) experienced extravasation was encountered in from the vessel during the procedure. During atherectomy, two (3.3%) of the subjects in the SFA group and one (1.9%) subject in the popliteal group experienced vessel dissection. Acute technical success in this study was 96.7% for SFA and 98.1% for the popliteal group. Overall technical success was 97.7%. In the first 72 h, three (5%) of the subjects in the SFA group and four (7.7%) of the subjects in the popliteal group experienced major adverse events. Acute procedural success in this study was 91.7% for SFA and 90.4% for the popliteal group. Overall procedural success was 91.1%. Success was defined as an improvement of at least one grade in the Rutherford classification; two (3.3%) subjects did not demonstrate improvements in the SFA group, and the clinical success rate was 96.7%. All subjects in the popliteal group demonstrated an improvement of at least one grade in the Rutherford classification, and clinical success was 100%. When the groups combined all subjects, the clinical success in this study was 98.2%.
CONCLUSION
Directional atherectomy with a Phoenix atherectomy system demonstrated comparable results with the literature.
Topics: Aged; Aged, 80 and over; Angioplasty, Balloon; Atherectomy; Equipment Design; Female; Humans; Lower Extremity; Male; Middle Aged; Peripheral Arterial Disease; Postoperative Complications; Retrospective Studies; Risk Factors; Treatment Outcome; Vascular Access Devices
PubMed: 30193549
DOI: 10.1177/1708538118797552 -
Atherectomy followed by drug-coated balloon angioplasty for below knee lesions in diabetic patients.Cirugia Y Cirujanos 2022The aim of this study was to compare the long-term outcomes of below the knee revascularization with percutaneous atherectomy followed by drug-coated balloon and...
OBJECTIVE
The aim of this study was to compare the long-term outcomes of below the knee revascularization with percutaneous atherectomy followed by drug-coated balloon and revascularization with drug-coated balloon alone for symptomatic diabetic patients with peripheral arterial disease.
PATIENTS AND METHODS
Between April 2015 and January 2020, total of 128 patients and 228 below the knee procedures were enrolled into this retrospective study. Sixty-five patients were treated with atherectomy followed by drug-coated balloon and 63 patients were treated solely with drug-coated balloon.
RESULTS
Technical success rates were similar in the AT+DCB group and DCB group. Target lesion revascularization (TLR) was found similar in both groups at 6-month follow-up. Clinically, driven repeat endovascular and surgical limb revascularization rates were also significantly lower at 12 and 24 months.
CONCLUSION
Combined usage of rotational atherectomy and drug-coated balloons for the treatment of diabetic patients with below-the knee arterial lesions and critical limb ischemia is associated with reduced long-term TLR rates and improved the long-term outcomes.
Topics: Humans; Angioplasty, Balloon; Atherectomy; Diabetes Mellitus; Retrospective Studies
PubMed: 36480761
DOI: 10.24875/CIRU.22000131 -
Journal of Endovascular Therapy : An... Apr 2009Compared to conventional percutaneous transluminal angioplasty (PTA) and stent implantation for arterial occlusive diseases, atherectomy offers the theoretical... (Review)
Review
Compared to conventional percutaneous transluminal angioplasty (PTA) and stent implantation for arterial occlusive diseases, atherectomy offers the theoretical advantages of eliminating stretch injury on arterial walls and reducing the, rate of restenosis. Historically, however, neither rotational nor directional atherectomy, whether used alone or with adjunctive PTA, has shown any significant long-term benefit over PTA alone in the coronary or peripheral arteries. However, the SilverHawk Plaque Excision System has produced positive results in single-center prospective registries of patients with femoropopliteal and infrainguinal lesions, with reduced adjunctive PTA, minimal adjunctive stenting, and competitive 6-month and 12-month patency rates. In the observational nonrandomized TALON (Treating Peripherals with SilverHawk: Outcomes Collection) registry, freedom from target lesion revascularization was 80% for 87 patients at 12 months. Questions remaining for further research with this device include more accurate determination of an event rate for distal embolization, the appropriate use of distal protection, the value of and appropriate circumstances for adjunctive angioplasty, and definitive patency and clinical outcomes. Other atherectomy devices are discussed.
Topics: Angioplasty, Balloon; Arterial Occlusive Diseases; Atherectomy; Atherectomy, Coronary; Constriction, Pathologic; Embolism; Equipment Design; Humans; Recurrence; Registries; Stents; Time Factors; Treatment Outcome; Vascular Patency
PubMed: 19624078
DOI: 10.1583/08-2656.1