Evaluation of Directional Atherectomy Studied by Intravascular Ultrasound in Femoropopliteal Artery Stenosis

Tielbeek, Alexander V.; Vroegindeweij, Dammis; Gussenhoven, Elma J.; Buth, Jacob; Landman, Guido H.M.

doi:10.1007/s002709900185

Cited by 10 publications

(5 citation statements)

References 35 publications

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“…[12][13][14][15][16] IVUS also enhances sensitivity for detecting procedural complications, including arterial dissections. [17][18][19][20][21][22] This may result in important changes to the treatment plan to minimize short-term peri-procedural complications. This systematic review also found that IVUS is an effective tool in diagnosing, characterizing, and evaluating iliofemoral venous disease.…”

Section: Discussionmentioning

confidence: 99%

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Intravascular ultrasound in peripheral venous and arterial interventions: A contemporary systematic review and grading of the quality of evidence

et al. 2022

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Although angiography has been the primary imaging modality used in peripheral vascular intervention, this technique has major limitations due to the evaluation of three-dimensional vessels in two dimensions. Intravascular ultrasound (IVUS) is an important adjunctive tool that can address some of these limitations. This systematic review assesses the appropriateness of IVUS as an imaging modality for guiding peripheral intervention through evidence collection and clinical appraisal of studies. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a cohort of 48 studies (29 arterial; 19 venous) detailing IVUS use in peripheral vascular intervention were extracted. Qualitative assessment of the studies evaluated pre- and postprocedure efficacy of IVUS and revealed that IVUS-guided peripheral intervention in arterial and venous diagnosis and treatment was superior to other imaging techniques alone. Each study in the cohort was further assessed for reliability and validity using the Oxford Centre for Evidence Based Medicine (CEBM) level of evidence scale. The majority of both arterial (79.3%) and venous (73.7%) studies received a 2b rating, the second highest level of evidence rating. The evidence to date indicates that IVUS results in better clinical outcomes overall and should be more widely adopted as an adjunctive imaging modality during peripheral intervention. (PROSPERO Registration No.: CRD42021232353)

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Section: Discussionmentioning

confidence: 99%

“…12 –16 IVUS also enhances sensitivity for detecting procedural complications, including arterial dissections. 17 –22 This may result in important changes to the treatment plan to minimize short-term peri-procedural complications.…”

Section: Discussionmentioning

confidence: 99%

Intravascular ultrasound in peripheral venous and arterial interventions: A contemporary systematic review and grading of the quality of evidence

et al. 2022

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“…Compared to PTA and stent implantation, they offer the theoretical advantages of eliminating stretch injury on arterial walls, limiting acute dissection (and the need for adjunctive stenting), and reducing elastic recoil, thereby potentially 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 coronary or peripheral arteries, 12,28–37 despite promising results in some single-center studies. 38…”

Section: History Of Atherectomy In the Coronary And Infrainguinal Arteriesmentioning

confidence: 99%

“…The theoretical advantages of atherectomy notwithstanding, a large amount of retained plaque was reported in a randomized trial of the Simpson device. 35 Despite numerous advances in cutter design or size of the Simpson catheter or other directional atherectomy devices, there was no documentation of any treatment success compared to the less expensive and simpler angioplasty balloons. Thus, atherectomy never gained acceptance as a primary method of treatment for PAD.…”

Section: History Of Atherectomy In the Coronary And Infrainguinal Arteriesmentioning

confidence: 99%

Atherectomy for Infrainguinal Peripheral Artery Disease

Garcia¹,

Lyden²

2009

Journal of Endovascular Therapy

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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.

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“…Despite any superior efficacy over only angioplasty alone in the coronary vasculature, there remains an interest in atherectomy for use in the peripheral vascular space. Given that current angioplasty and stenting data have not shown as much long‐term success, there is a growing interest in alternative athero‐ablative technologies 7–17 . The peripheral arteries, in particular the infra‐inguinal territory, undergo many dynamic forces that make translation of the coronary interventional literature to the peripheral vasculature not as relevant.…”

Section: Introductionmentioning

confidence: 99%

Peripheral Atherectomy: A Critical Review

Bunting

Garcia

2007

J Interven Cardiology

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Atherectomy is experiencing increased interest from endovascular specialists as a therapeutic treatment in the peripheral arteries. Long studied in the coronary vasculature, atherectomy has several theoretical advantages that make it uniquely suited for the peripheral circulation. In particular, infra-inguinal peripheral arterial disease experiences physiologic stresses and forces that have made traditional percutaneous coronary treatments such as angioplasty and stenting not as successful. Restenosis has been a major problem for angioplasty and stenting alone. The SilverHawk atherectomy device has favorable short-term data but important longer-term data are limited and need further study. Laser atherectomy also has favorable applications in niche patients but the number of studies is limited. Unfortunately, athero-ablative technologies for peripheral arterial disease require more definitive objective data regarding 12-month and longer-term outcomes in order to obtain widespread scientific acceptance.

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Evaluation of Directional Atherectomy Studied by Intravascular Ultrasound in Femoropopliteal Artery Stenosis

Abstract: Lumen enlargement following DA is predominantly due to plaque excision. Vessel expansion combined with plaque excision varies in different stenoses and is an important factor in eccentric and soft lesions. Despite additional DA considerable plaque remains.

Cited by 10 publications

References 35 publications

Intravascular ultrasound in peripheral venous and arterial interventions: A contemporary systematic review and grading of the quality of evidence

Intravascular ultrasound in peripheral venous and arterial interventions: A contemporary systematic review and grading of the quality of evidence

Atherectomy for Infrainguinal Peripheral Artery Disease

Peripheral Atherectomy: A Critical Review

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