Atherectomy offers no benefits over balloon angioplasty in tibial interventions for critical limb ischemia

Todd, Kevin; Ahanchi, Sadaf S.; Maurer, Christian A.; Kim, Jung Ho; Chipman, Candice R.; Panneton, Jean M.

doi:10.1016/j.jvs.2013.04.024

Cited by 51 publications

(52 citation statements)

References 22 publications

(20 reference statements)

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“…Furthermore, despite concerns for prolonged procedure times with atherectomy, we demonstrated a shorter procedure duration, similar contrast utilization, and comparable complication rates. As such, atherectomy may prove to be important in BTK revascularization as an adjunctive therapy to PTA or DCB angioplasty pending adequately power randomized trials with relevant clinical outcomes.…”

Section: Discussionmentioning

confidence: 76%

“…The small CALCIUM 360 pilot trial ( n = 50) revealed no significant difference in target vessel revascularization or amputation at 1 year . A retrospective single‐center study of 418 tibial interventions (19% atherectomy) in patients with CLI showed no improvement in primary patency nor limb salvage at 12 and 36 months . Both study results need to be interpreted with caution given the small number of atherectomy patients and/or lack of randomization; however, these studies contribute to the current clinical equipoise.…”

Section: Discussionmentioning

confidence: 94%

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Atherectomy in below‐the‐knee endovascular interventions: One‐year outcomes from the XLPAD registry

Khalili

Jeon–Slaughter

Armstrong

et al. 2018

Cathet Cardio Intervent

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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.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 94%

Atherectomy in below‐the‐knee endovascular interventions: One‐year outcomes from the XLPAD registry

Khalili

Jeon–Slaughter

Armstrong

et al. 2018

Cathet Cardio Intervent

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“…Definitive clinical benefit of atherectomy over PTA is not clear. A retrospective study of 418 tibial interventions for CLI found no benefit over PTA, and this study used variety of atherectomy devices including directional, orbital and laser [88].…”

Section: Atherectomymentioning

confidence: 95%

Endovascular therapy for critical limb ischemia

Domínguez

Bahadorani

Reeves

et al. 2015

Expert Review of Cardiovascular Therapy

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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.

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“…Procedures were mainly performed for CLI treatment. According to Kaplan–Meier analysis, there was no difference at 12- and 36-month follow-up in primary patency (69, 55% vs. 61, 46%; p = 0.158), assisted primary patency (83, 71% vs. 85, 67%; p = 0.801), limb salvage (79, 70% vs. 81, 77%; p = 0.485) and survival (77, 56% vs. 80, 50%; p = 0.944) between balloon angioplasty and atherectomy-assisted group [33]. …”

Section: Multicenter Prospective Registries and Large Retrospective Cmentioning

confidence: 99%

Debulking Atherectomy in the Peripheral Arteries: Is There a Role and What is the Evidence?

Κατσάνος

Spiliοpoulos

Reppas

et al. 2017

Cardiovasc Intervent Radiol

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Traditional percutaneous balloon angioplasty and stent placement is based on mechanical plaque disruption and displacement within the arterial wall. On the contrary, transcatheter atherectomy achieves atherosclerotic plaque clearance by means of directional plaque excision or rotational plaque removal or laser plaque ablation. Debulking atherectomy may allow for a more uniform angioplasty result at lower pressures with consequently less vessel barotrauma and improved luminal gain, thereby decreasing the risk of plaque recoil and dissection that may require permanent metal stenting. It has been also argued that atherectomy may disrupt the calcium barrier and optimize drug transfer and delivery in case of drug-coated balloon applications. The authors discuss the various types of atherectomy devices available in clinical practice to date and critically appraise their mode of action as well as relevant published data in each case. Overall, amassed randomized and observational evidence indicates that percutaneous atherectomy of the femoropopliteal and infrapopliteal arteries may achieve high technical success rates and seems to lessen the frequency of bailout stenting, however, at the expense of increased risk of peri-procedural distal embolization. Long-term clinical outcomes reported to date do not support the superiority of percutaneous atherectomy over traditional balloon angioplasty and stent placement in terms of vessel patency or limb salvage. The combination of debulking atherectomy and drug-coated balloons has shown promise in early studies, especially in the treatment of more complex lesions. Unanswered questions and future perspectives of this continuously evolving endovascular technology as part of a broader treatment algorithm are discussed.

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Atherectomy offers no benefits over balloon angioplasty in tibial interventions for critical limb ischemia

Cited by 51 publications

References 22 publications

Atherectomy in below‐the‐knee endovascular interventions: One‐year outcomes from the XLPAD registry

Atherectomy in below‐the‐knee endovascular interventions: One‐year outcomes from the XLPAD registry

Endovascular therapy for critical limb ischemia

Debulking Atherectomy in the Peripheral Arteries: Is There a Role and What is the Evidence?

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