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Atherectomy in below-the-knee endovascular interventions: One-year outcomes from the XLPAD registry.Catheterization and Cardiovascular... Feb 2019Use of atherectomy for the treatment of peripheral arterial disease (PAD) is increasing as an adjunctive treatment to either conventional or drug-coated balloon...
BACKGROUND
Use of atherectomy for the treatment of peripheral arterial disease (PAD) is increasing as an adjunctive treatment to either conventional or drug-coated balloon angioplasty. There is limited data on atherectomy outcomes in below-the-knee (BTK) endovascular interventions.
METHODS
Data from the multicenter Excellence in Peripheral Artery Disease (XLPAD) registry (NCT01904851) were analyzed to examine predictors of atherectomy use and its associated 1-year patency rate. We analyzed 518 BTK procedures performed between January 2005 and December 2016.
RESULTS
Overall a total of 518 BTK procedures were treated in 430 patients, and 43% of interventions used atherectomy. African American patients were less likely (13% vs 25%; |standard residual| = 3.41) to be treated with atherectomy. Use of atherectomy was lower in chronic total occlusive (CTO) lesions (48% vs 58%; P = 0.02). There were no significant associations of baseline comorbidities, critical limb ischemia (CLI), ankle-brachial index, number of BTK vessel run-off, or vessel location with atherectomy use. Compared with patients without atherectomy, use of atherectomy was associated with lower incidence of repeat target limb intervention at 1 year after adjusting for age, CLI, in-stent restenosis, heavy calcification, presence of diffuse disease, and CTO lesion traits (Hazard Ratio 0.41, 95% confidence interval 0.23-0.72; P < 0.01).
CONCLUSIONS
Compared with no atherectomy, use of atherectomy in BTK interventions is associated with lower rates of 1-year repeat target limb revascularization. These findings require confirmation in prospective, randomized clinical studies.
Topics: Aged; Atherectomy; Female; Humans; Leg; Male; Middle Aged; Peripheral Arterial Disease; Registries; Risk Factors; Time Factors; Treatment Outcome; United States; Vascular Patency
PubMed: 30499198
DOI: 10.1002/ccd.27897 -
Herz Dec 1997Rotational atherectomy (Rotablation) represents one of the alternative devices to treat complex coronary artery stenoses. Rather than increasing luminal diameter by... (Review)
Review
Rotational atherectomy (Rotablation) represents one of the alternative devices to treat complex coronary artery stenoses. Rather than increasing luminal diameter by arterial stretching and plaque fracture as with balloon angioplasty, rotablation debulks atherosclerotic plaque with an abrasive diamond coated burr. The basic physical principle is differential cutting. It allows the advancing burr to selectively cut inelastic material while elastic tissue deflects away from the burr. 95% of the particles generated by the Rotablator are less than 5 microns. They are removed by the body's reticuloendothelial system. There are different strategies to perform a rotablation, regarding the number of burrs used and the final burr-to-artery ratio. An adjunctive PTCA is recommended without proof by randomized studies so far. The best indication for the Rotablator is the undilatable lesion. Lesion modification (debulking) as a method of improving vessel compliance seems to be also usefull in diffusely diseased and calcified vessels, as well as in aorto-ostial and angulated stenoses. The instent restenoses is a new indication. Randomized studies will have to proof if there is an advantage for rotablation compared to PTCA. Restenosis rates appear comparable to balloon angioplasty.
Topics: Angioplasty, Balloon, Coronary; Atherectomy, Coronary; Contraindications; Coronary Disease; Humans
PubMed: 9483434
DOI: 10.1007/BF03044279 -
Journal of Endovascular Therapy : An... Oct 2020
Topics: Atherectomy; Humans; Intermittent Claudication; Treatment Outcome
PubMed: 32744120
DOI: 10.1177/1526602820944610 -
Circulation. Cardiovascular... Nov 2016
Topics: Angioplasty, Balloon, Coronary; Atherectomy, Coronary; Coronary Angiography; Drug-Eluting Stents; Treatment Outcome
PubMed: 27974433
DOI: 10.1161/CIRCINTERVENTIONS.116.004571 -
Cardiovascular Revascularization... Mar 2019
Topics: Atherectomy, Coronary; Coronary Artery Disease; Humans; Radial Artery
PubMed: 30904137
DOI: 10.1016/j.carrev.2019.01.009 -
Circulation. Cardiovascular... Feb 2020
Topics: Atherectomy, Coronary; Coronary Artery Disease; Humans; Registries; Vascular Calcification
PubMed: 31973556
DOI: 10.1161/CIRCINTERVENTIONS.119.008789 -
Der Radiologe Jan 2010Peripheral arterial occlusive disease (PAOD) is still an extremely important politico-economic disease. Diverse treatment procedures exist but the pillars of therapy are... (Comparative Study)
Comparative Study Review
Peripheral arterial occlusive disease (PAOD) is still an extremely important politico-economic disease. Diverse treatment procedures exist but the pillars of therapy are changes in lifestyle, such as nicotine abstinence and walking exercise as well as drug therapy. Further therapy options are considered after conventional procedures have been exhausted. These further options consist of improvement of the blood supply by surgical or minimally invasive procedures. The latter therapy options include balloon dilatation and stenting as the most widely used techniques. More recent techniques also used are cryoplasty, laser angioplasty, drug-coated stents or balloons as well as brachytherapy or atherectomy, whereby this list makes no claims to completeness. The multitude of different treatment methods emphatically underlines the fact that no resounding success can be achieved with one single method. The long-term results of both balloon dilatation and stenting techniques show a need for improvement, which elicited the search for additional methods for the treatment of PAOD. Atherectomy represents such an alternative method for treatment of PAOD. Basically, the term atherectomy means the removal of atheroma tissue. For percutaneous atherectomy, in contrast to surgical procedures, it is not necessary to create surgically access to the vessel but accomplishes the atherectomy by means of dedicated systems via a minimally invasive access. There are two basic forms of mechanical atherectomy: directional and rotational systems.
Topics: Aged, 80 and over; Angiography; Arterial Occlusive Diseases; Atherectomy; Catheterization; Embolism; Equipment Design; Female; Follow-Up Studies; Humans; Minimally Invasive Surgical Procedures; Secondary Prevention; Stents; Thrombectomy
PubMed: 20013334
DOI: 10.1007/s00117-009-1913-0 -
The Journal of Invasive Cardiology Jan 2014Revascularization of the peripheral arteries remains technically challenging. By decreasing the volume of the atherosclerotic plaque, debulking procedures may confer... (Comparative Study)
Comparative Study Review
BACKGROUND
Revascularization of the peripheral arteries remains technically challenging. By decreasing the volume of the atherosclerotic plaque, debulking procedures may confer superior primary patency after revascularization.
AIMS
To assess the impact of atherectomy on primary patency rates at 12 months compared to balloon angioplasty and/or stent placement alone in patients with infrainguinal arterial disease.
METHODS
A database search for "directional," "orbital," "rotational," and "laser atherectomy" in peripheral arterial disease (PAD) was performed. Studies were screened according to the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) critical appraisal tool and summarized by population, methodology, and outcomes (primary patency and major adverse events).
RESULTS
Only two randomized studies were found. Most of the data were obtained from single-arm studies and registries. The primary patency with directional atherectomy approaches 60% at 12 months as a stand-alone technique, whereas orbital atherectomy in conjunction with balloon angioplasty and stenting achieved primary patency rates of 90%. Laser atherectomy is universally employed with balloon angioplasty and stenting for in-stent restenosis lesions with a primary patency rate of 64%. Although there are data for the safe use of rotational atherectomy, robust data to support its effectiveness are lacking. The combination of drug-coated balloons and atherectomy for the treatment of heavily calcified lesions in patients with critical limb ischemia is under evaluation.
CONCLUSION
Despite the successful procedural outcomes reported in clinical registries, the available data do not support the use of atherectomy alone in PAD. Larger randomized controlled studies are warranted to define its role in contemporary endovascular practice.
Topics: Aged; Aged, 80 and over; Angioplasty, Balloon; Atherectomy; Combined Modality Therapy; Databases, Factual; Humans; Inguinal Canal; Middle Aged; Peripheral Arterial Disease; Retrospective Studies; Stents; Treatment Outcome; Vascular Patency
PubMed: 24402808
DOI: No ID Found -
Annals of Vascular Surgery May 2021
Topics: Atherectomy; Endovascular Procedures; Humans; Medical Overuse; Medicare; Michigan; Peripheral Arterial Disease; Reimbursement, Incentive; United States
PubMed: 33485907
DOI: 10.1016/j.avsg.2021.01.061 -
Catheterization and Cardiovascular... Jan 2021Stent under-expansion (rather than intimal hyperplasia) may be the cause of in-stent restenosis. Later expansion of coronary stents that were not fully deployed...
Stent under-expansion (rather than intimal hyperplasia) may be the cause of in-stent restenosis. Later expansion of coronary stents that were not fully deployed initially, can be difficult. Atherectomy is one method of facilitating late stent expansion, but too few patients have been treated to determine the risk benefit ratio.
Topics: Atherectomy; Coronary Angiography; Coronary Restenosis; Feasibility Studies; Humans; Stents; Treatment Outcome
PubMed: 33460265
DOI: 10.1002/ccd.29452