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Kardiologia Polska Jun 2020
Topics: Atherectomy, Coronary; Humans; Percutaneous Coronary Intervention; Radial Artery
PubMed: 32589378
DOI: 10.33963/KP.15450 -
Annals of Vascular Surgery May 2018Atherectomy has become an increasingly utilized modality for the endovascular treatment of peripheral arterial occlusive disease. The objective of this study was to...
BACKGROUND
Atherectomy has become an increasingly utilized modality for the endovascular treatment of peripheral arterial occlusive disease. The objective of this study was to determine the incidence and risk factors for atherectomy-associated complications.
METHODS
A retrospective review was performed for all atherectomy procedures performed between January 2011 and December 2015 in the Southern California Vascular Outcomes Improvement Collaborative. Atherectomy was defined as laser, orbital, or excisional atherectomy. Complications were dissection, perforation, and distal embolization.
RESULTS
Seven hundred twenty-nine atherectomy procedures were performed at 7 institutions by 27 practitioners. The mean age was 73 years with 415 (57%) males. Four hundred nineteen (57%) were diabetic, 673 (92%) hypertensive, 457 (63%) smokers, and 244 (34%) had coronary artery disease. Dissection occurred in 51 (7%) procedures, embolization in 23 (3.1%), and perforation in 12 (1.6%). The mean number of lesions treated per artery was the same at 1.6 in patients with any complication and no complication (P = 0.77). The total occluded length was 7.4 cm for complications versus 7.2 cm for no complication (P = 0.73). The total treated length was 12.9 cm for complications versus 11.3 cm for no complication (P = 0.03). The incidence of complications for Trans-Atlantic Inter-Society Consensus (TASC) C/D lesions were 13% compared to 10% for TASC A/B lesions (P = 0.05). The incidence of complications in superficial femoral/popliteal lesions was 12.9% vs. 10.4% in tibial lesions (P = 0.13). In multivariable analysis, treatment length was associated with a small increased risk of complication (odds ratio = 1.02, 95% confidence interval = 1.0-1.04).
CONCLUSIONS
Increased treatment length is associated with an increased risk of atherectomy-associated complications. Demographic factors and comorbidities were not predictors of complications.
Topics: Aged; Atherectomy; California; Chi-Square Distribution; Female; Humans; Incidence; Logistic Models; Male; Multivariate Analysis; Odds Ratio; Postoperative Complications; Registries; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome
PubMed: 29197604
DOI: 10.1016/j.avsg.2017.11.029 -
Kardiologia Polska 2024
Topics: Humans; Calcium; Atherectomy; Atherectomy, Coronary; Treatment Outcome; Vascular Calcification; Coronary Artery Disease; Severity of Illness Index
PubMed: 38348618
DOI: 10.33963/v.phj.98836 -
BMC Surgery 2012The incidence of lower extremity peripheral artery disease (LE-PAD) continues to increase and associated morbidity remains high. Despite the significant development of... (Review)
Review
BACKGROUND
The incidence of lower extremity peripheral artery disease (LE-PAD) continues to increase and associated morbidity remains high. Despite the significant development of percutaneous revascularization strategies, over the past decade, LE-PAD still represents a unique challenge for interventional cardiologists and vascular surgeons.
METHOD
Typical features of atherosclerosis that affects peripheral vascular bed (diffuse nature, poor distal runoff, critical limb ischemia, chronic total occlusion) contribute to the disappointing results of traditional percutaneous transluminal angioplasty (PTA). New technologies have been developed in attempt to improve the safety and effectiveness of percutaneous revascularization. Among these, atherectomy, debulking and removing atherosclerotic plaque, offers the potential advantage of eliminating stretch on arterial walls and reducing rates of restenosis.
CONCLUSIONS
This review summarizes the features and the current applications of new debulking devices.
Topics: Atherectomy; Humans; Lower Extremity; Peripheral Arterial Disease; Recurrence; Treatment Outcome
PubMed: 23173800
DOI: 10.1186/1471-2482-12-S1-S13 -
Circulation Journal : Official Journal... Mar 2018
Topics: Atherectomy, Coronary; Coronary Artery Disease; Coronary Restenosis; Drug-Eluting Stents; Humans
PubMed: 29515046
DOI: 10.1253/circj.CJ-18-0170 -
JACC. Cardiovascular Interventions May 2022
Topics: Anaphylaxis; Atherectomy; Atherectomy, Coronary; Coronary Angiography; Coronary Artery Disease; Humans; Percutaneous Coronary Intervention; Retrospective Studies; Severity of Illness Index; Treatment Outcome; Vascular Calcification
PubMed: 35589245
DOI: 10.1016/j.jcin.2022.02.008 -
The Journal of Cardiovascular Surgery Aug 2016Atherectomy has been used as an adjunct therapy for balloon angioplasty and/or stent placement in the superficial femoral artery for many years, but has never gained... (Review)
Review
Atherectomy has been used as an adjunct therapy for balloon angioplasty and/or stent placement in the superficial femoral artery for many years, but has never gained global popularity in the treatment of peripheral arterial disease, most probably related to the conflicting results as published in the literature. Novel techniques that have been developed over the past years are yielding promising results in the infrainguinal region. This paper will describe the added benefits of atherectomy as compared to plain old balloon angioplasty and bail-out bare-metal stenting, both in the treatment of primary lesions of the superficial femoral artery as well as in cases of in-stent restenosis.
Topics: Angioplasty, Balloon; Atherectomy; Constriction, Pathologic; Femoral Artery; Humans; Lower Extremity; Peripheral Arterial Disease; Recurrence; Risk Factors; Stents; Treatment Outcome
PubMed: 27102630
DOI: No ID Found -
Catheterization and Cardiovascular... Mar 2016Calcified lesions are associated with lower rates of successful percutaneous coronary intervention (PCI), greater stent thrombosis, and increased target vessel...
Calcified lesions are associated with lower rates of successful percutaneous coronary intervention (PCI), greater stent thrombosis, and increased target vessel revascularization. Women undergoing PCI are more often older than men and likely to present with severe lesion calcification. The ORBIT II study, for the first time compares the effect of the orbital atherectomy system (OAS) in men and women undergoing PCI for severely calcified lesions. Although the adjusted risk of severe dissections was higher in women, the incidence of in-hospital and 30-day outcomes was similar to men. Randomized comparisons of the OAS with rotational atherectomy and with stenting without atherectomy are needed to further elucidate sex-based differences in calcified lesion PCI.
Topics: Atherectomy; Atherectomy, Coronary; Female; Humans; Male; Percutaneous Coronary Intervention; Treatment Outcome; Vascular Calcification
PubMed: 26994977
DOI: 10.1002/ccd.26492 -
The Surgical Clinics of North America Aug 1998Endovascular interventions for the treatment of lower-extremity atherosclerotic disease have undergone a rapid course of development during the past 30 years. Balloon... (Review)
Review
Endovascular interventions for the treatment of lower-extremity atherosclerotic disease have undergone a rapid course of development during the past 30 years. Balloon angioplasty is the most widely applied of these techniques and has been shown to yield excellent results, at least in the short and intermediate terms, in appropriately selected patients. The ideal candidate is one with a focal stenotic lesion of the iliac artery; this is also the type of patient in whom placement of an endoluminal stent, whether primarily or as an adjunct to balloon angioplasty, has been shown to be most effective. The initial enthusiasm for transluminal atherectomy of lower-extremity atherosclerotic lesions has met with some disappointing long-term results. It is now used mainly in conjunction with either or both of the above modalities in a select group of patients. Clearly, more controlled studies of all these techniques are needed to better define their exact indications and limitations in treatment of lower-extremity arterial disease.
Topics: Angioplasty, Balloon; Arteriosclerosis; Atherectomy; Humans; Iliac Artery; Intermittent Claudication; Leg; Peripheral Vascular Diseases; Stents
PubMed: 9728203
DOI: 10.1016/s0039-6109(05)70336-4 -
Journal of Vascular Surgery Jan 2021The effectiveness of rotational atherectomy in the treatment of complex superficial femoral artery (SFA) lesions remains poorly defined. Outcomes of SFA lesions treated...
BACKGROUND
The effectiveness of rotational atherectomy in the treatment of complex superficial femoral artery (SFA) lesions remains poorly defined. Outcomes of SFA lesions treated with rotational atherectomy were analyzed.
METHODS
This retrospective review assessed all patients who underwent rotational atherectomy of the SFA at a single institution between 2015 and 2018. The data of all patients were deidentified, and the study was approved by the Institutional Review Board. Informed consent was not obtained for this retrospective analysis. Main outcomes were Kaplan-Meier primary patency rate, freedom from major amputation, and 2-year survival rate. The effect of drug-coated balloon angioplasty (DCBA) on patency and time to death was investigated with univariate regression. The safety profile for atherectomy and DCBA was assessed by the 30-day incidence of major amputation and all-cause mortality.
RESULTS
Fifty-three patients (mean age, 70.2 ± 9.8 years; 73% male; 65% critical limb-threatening ischemia; 47 [90%] current or former smokers; seven [13%] with prior failed ipsilateral endovascular intervention) underwent rotational atherectomy (Jetstream; Boston Scientific, Marlborough, Mass) with mean follow-up of 543 days. Forty-six (87%) patients underwent DCBA (Lutonix; BD Bard, Covington, Ga) after atherectomy. Mean lesion length was 13.2 ± 9.0 cm. Thirty-one (58%) lesions were TransAtlantic Inter-Society Consensus C or D class. At 1-month follow-up, 39 of 45 (87%) patients experienced improvement in symptoms and Rutherford class. An improvement in ankle-brachial index was also noted in 13% of patients without improvement of symptoms, with no patients progressing to surgical bypass or major amputation. Mean ankle-brachial index increased from 0.54 ± 0.035 to 0.90 ± 0.031 at 1 month after intervention (P < .001) and remained constant out to 18 months. Mean toe pressure increased from 36 ± 3.8 mm Hg to 67 ± 4.5 mm Hg at 1 month after intervention (P < .001) and remained constant out to 18 months. Kaplan-Meier primary patency rate was 75% (95% confidence interval, 61%-85%) at 12 months and 65% (51%-77%) at 24 months. There was a trend toward improved primary patency after adjunctive DCBA compared with plain balloon angioplasty at 1 year (75% vs 43%; P = .1082). There was no significant difference in mortality between adjunctive DCBA and plain balloon angioplasty at 2 years (11% vs 0%). The 2-year incidence of major amputation in critical limb-threatening ischemia patients was 3.9% (1.2%-6.5%). One patient died and none underwent amputation within 30 days.
CONCLUSIONS
Rotational atherectomy with adjunctive DCBA of long SFA lesions has excellent long-term patency. Two-year major amputation and mortality rates are low, and the technique has an exceptional safety profile.
Topics: Aged; Aged, 80 and over; Atherectomy; Female; Femoral Artery; Humans; Male; Middle Aged; Peripheral Arterial Disease; Retrospective Studies; Treatment Outcome
PubMed: 32325226
DOI: 10.1016/j.jvs.2020.03.040