Directional Atherectomy With Antirestenotic Therapy vs Drug-Coated Balloon Angioplasty Alone for Isolated Popliteal Artery Lesions

Stavroulakis, Konstantinos; Schwindt, Arne; Torsello, Giovanni; Stachmann, Arne; Hericks, Christiane; Bosiers, Michel; Beropoulis, Efthymios; Stahlhoff, Stefan; Bisdas, Theodosios

doi:10.1177/1526602816683933

Cited by 71 publications

(56 citation statements)

References 28 publications

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“…22 A comparative study was published in 2017 with 31 patients treated with DCBs and 41 patients with DAART for isolated lesions of the popliteal artery. 23 The 1-year primary patency was higher in patients treated with DAART (82% vs. 65%; hazard ratio, 2.64; 95% confidence interval, 1.09 to 6.37, P ¼ 0.021), and secondary patency was the same between the 2 modalities at 96%. The rate of popliteal occlusion was similar to that presented in our investigation (36% DCB, 44% DAART, 42% our study).…”

Section: Discussionmentioning

confidence: 86%

Real-World Results of Supera Stent Implantation for Popliteal Artery Atherosclerotic Lesions: 3-Year Outcome

Norberto

Flota

Domingos

et al. 2020

Annals of Vascular Surgery

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Section: Discussionmentioning

confidence: 86%

Real-World Results of Supera Stent Implantation for Popliteal Artery Atherosclerotic Lesions: 3-Year Outcome

Norberto

Flota

Domingos

et al. 2020

Annals of Vascular Surgery

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“…Nonetheless, both the current literature and the findings of this real-world IN.PACT Global Study suggest that the unique anatomical environment in which the popliteal artery is embedded possesses different challenges compared to the proximal and middle SFA. 63 It remains, however, difficult to explain why lesions affecting both the SFA and the popliteal artery performed worse than isolated SFA or popliteal disease. We assume that a geometrical mismatch might play a vital role.…”

Section: Discussionmentioning

confidence: 99%

Three-Year Sustained Clinical Efficacy of Drug-Coated Balloon Angioplasty in a Real-World Femoropopliteal Cohort

et al. 2020

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Purpose: To report the 36-month outcomes from the prospective, multicenter, single-arm IN.PACT Global Study ( ClinicalTrials.gov identifier NCT01609296) evaluating the performance of the IN.PACT Admiral drug-coated balloon (DCB) in real-world patients with femoropopliteal occlusive disease. Materials and Methods: The IN.PACT Global Study was conducted at 64 international sites and enrolled 1535 patients with complex lesions, which included bilateral disease, multiple lesions, de novo in-stent restenosis, long lesions, and chronic total occlusions. The predefined full clinical cohort included 1406 patients (mean age 68.6 years; 67.8% men) with claudication or rest pain treated with the study DCB. Mean lesion length was 12.09±9.54 cm; 18.0% had in-stent restenosis, 35.5% were totally occluded, and 68.7% were calcified. Freedom from clinically-driven target lesion revascularization (CD-TLR) was evaluated through 36 months. The safety composite endpoint was freedom from device- and procedure-related death through 30 days and freedom from major target limb amputation and clinically-driven target vessel revascularization within 36 months. All safety and revascularization events were reviewed by an independent clinical events committee. Results: The Kaplan-Meier estimate of freedom from CD-TLR through 36 months was 76.9%. The composite safety endpoint was achieved in 75.6% of patients. The 36-month all-cause mortality rate was 11.6%, and the major target limb amputation rate was 1.0%. The Kaplan-Meier estimate of freedom from CD-TLR through 36 months was significantly lower in patients with chronic limb-threatening ischemia (CLTI) compared with claudicants (67.6% vs 78.0%; p=0.003). Lesions affecting both the superficial femoral artery (SFA) and popliteal artery had lower Kaplan-Meier freedom from CD-TLR through 36 months (69.2%) than either isolated SFA (79.7%) or popliteal artery lesions (76.5%; log- rank p<0.001). Predictors of CD-TLR through 36 months included increased lesion length, reference vessel diameter ≤4.5 mm, in-stent restenosis, bilateral disease, CLTI, and hyperlipidemia. Conclusion: DCB angioplasty with the IN.PACT Admiral DCB for femoropopliteal disease in a diverse and complex real-world population is associated with sustained clinical efficacy and low rates of reinterventions at 3 years after the initial procedure.

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“…9 Our group reported on the directional atherectomy with antirestenotic therapy (DAART) versus DCB angioplasty for isolated popliteal lesions. 10 In that study, 41 patients were treated with DAART, including the TurboHawk atherectomy catheter (Medtronic), the SilverHawk (Medtronic) peripheral plaque excision system and the HawkOne atherectomy device (Medtronic); and the Pantheris optical coherence tomography atherectomy catheter (Avinger) and 31 with DCB angioplasty only. The results showed a higher technical success rate (93% versus 84%, p=0.24) and primary patency rate at 6 months with DAART (95% versus 79%).…”

Section: Discussionmentioning

confidence: 99%

Use of the Orbital Atherectomy System in Isolated, Chronic Atherosclerotic Lesions of the Popliteal Artery

Lebruno

Donas

Fazzini

et al. 2020

Vascular and Endovascular Review

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The treatment of isolated calcified lesions involving the popliteal artery are demanding and they often require stent placement to achieve acceptable luminal gain. This study evaluates the safety and performance of the orbital atherectomy system (Cardiovascular Systems Inc.) and percutaneous transluminal angioplasty with a drug-coated balloon (PTA-DCB) for the treatment of chronic atherosclerotic lesions within the popliteal artery segment. From November 2018 to November 2019, a series of six patients with Rutherford classification stage III peripheral arterial disease with isolated, focal, calcified occlusions of the popliteal artery were treated with orbital atherectomy followed by PTA-DCB. No embolic protection devices were used. The technical success rate was 100%, the primary patency rate was 100% at 7.0 (±4.2) months of follow-up. The Rutherford classification improved in all patients from stage III to stage II and the mean ankle brachial pressure index after the procedure was 0.97 (±0.08), with a preoperative mean ankle brachial pressure index of 0.69 (±0.21). In one instance, spasm was noted in a distal arterial bed and it was successfully treated with local nitroglycerine. No distal embolisation, perforation or aneurysmal degeneration was observed. During follow-up there were no deaths, major amputations or revascularisation of target lesions. The use of orbital atherectomy system in combination with PTA-DCB was found to be safe and effective in modifying focal, chronic, calcified plaques in the popliteal artery segment in these six cases.

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Directional Atherectomy With Antirestenotic Therapy vs Drug-Coated Balloon Angioplasty Alone for Isolated Popliteal Artery Lesions

Cited by 71 publications

References 28 publications

Real-World Results of Supera Stent Implantation for Popliteal Artery Atherosclerotic Lesions: 3-Year Outcome

Real-World Results of Supera Stent Implantation for Popliteal Artery Atherosclerotic Lesions: 3-Year Outcome

Three-Year Sustained Clinical Efficacy of Drug-Coated Balloon Angioplasty in a Real-World Femoropopliteal Cohort

Use of the Orbital Atherectomy System in Isolated, Chronic Atherosclerotic Lesions of the Popliteal Artery

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