Current Role of Atherectomy for Treatment of Femoropopliteal and Infrapopliteal Disease

Shammas, Nicolas W.

doi:10.1016/j.iccl.2016.12.007

Cited by 7 publications

(8 citation statements)

References 68 publications

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“…Our study provides novel insights into the contemporary use and 10 Debulking strategies using atherectomy devices have shown improvement in immediate luminal gain and less need for stenting compared with PTA; this is primarily due to lower requirement for high balloon inflation pressures to achieve optimal vessel expansion and as a result, a lower dissection rate. [13][14][15] Evidence for the use of atherectomy in lower extremity interventions is mixed.…”

Section: Discussionmentioning

confidence: 86%

“…Use of each device can be lesion dependent. For example, directional devices are more likely to be used in short eccentric or CTO lesions, while rotational devices are commonly used for long calcified and CTO lesions . Debulking strategies using atherectomy devices have shown improvement in immediate luminal gain and less need for stenting compared with PTA; this is primarily due to lower requirement for high balloon inflation pressures to achieve optimal vessel expansion and as a result, a lower dissection rate …”

Section: Discussionmentioning

confidence: 99%

“…Original Studies and thrombosis. 10 Furthermore, there is currently no approved stent for BTK revascularization. Given these limitations, atherectomy is appealing for debulking of atherosclerotic plaque either as a standalone therapy or adjunctive to percutaneous transluminal angioplasty (PTA).…”

Section: P E R I P H E R a L V A S C U L A R D I S E A S Ementioning

confidence: 99%

“…Tibial arteries often have medial calcification, limiting PTA efficacy due to vessel recoil, dissection, and high rates of target vessel revascularization (TVR) . Use of long stents in below‐the‐knee (BTK) lesions can be complicated by under‐expansion, compression, fracture, and thrombosis . Furthermore, there is currently no approved stent for BTK revascularization.…”

Section: Introductionmentioning

confidence: 99%

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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: 86%

Section: Discussionmentioning

confidence: 99%

Section: P E R I P H E R a L V A S C U L A R D I S E A S Ementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…Nowadays, PAD is mainly treated with endovascular therapy, which can be performed with different methods such as percutaneous transluminal angioplasty (PTA), mechanical or laser atherectomy, or stent implantation (Norgren et al 2007; Shammas 2017). With the invention of drug-eluting technology, the field has actively favored the strategy of “leaving nothing behind” (Bosiers 2013; Casserly 2017).…”

Section: Introductionmentioning

confidence: 99%

Prediction of restenosis based on hemodynamical markers in revascularized femoro-popliteal arteries during leg flexion

Gökgöl

Diehm²,

Räber

et al. 2019

Biomech Model Mechanobiol

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Endovascular therapy in patients suffering from peripheral arterial disease shows high rates of restenosis. The poor clinical outcomes are commonly explained by the demanding mechanical environment due to leg movements, but the mechanisms responsible for restenosis remain unknown. In this study, we hypothesized that restenosis following revascularization is associated with hemodynamical markers derived from blood flow during leg flexion. Therefore, we performed personalized computational fluid dynamics (CFD) analyses of 20 patients, who underwent routine endovascular femoro-popliteal interventions. The CFD analyses were conducted using 3D models of the arterial geometry in straight and flexed positions, which were reconstructed from 2D angiographic images. Based on restenosis rates reported at 6-month follow-up, logistic regression analyses were performed to predict restenosis from hemodynamical parameters. Results showed that severe arterial deformations, such as kinking, induced by leg flexion in stented arteries led to adverse hemodynamic conditions that may trigger restenosis. A logistic regression analysis based solely on hemodynamical markers had an accuracy of 75%, which showed that flow parameters are sufficient to predict restenosis (p = 0.031). However, better predictions were achieved by adding the treatment method in the model. This suggests that a more accurate image acquisition technique is required to capture the localized modifications of blood flow following intervention, especially around the stented artery. This approach, based on the immediate postoperative configuration of the artery, has the potential to identify patients at increased risk of restenosis. Based on this information, clinicians could take preventive measures and more closely follow these patients to avoid complications.Electronic supplementary materialThe online version of this article (10.1007/s10237-019-01183-9) contains supplementary material, which is available to authorized users.

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Percutaneous Revascularization of the Tibial Arteries

Katsanos

2024

Mastering Endovascular Techniques

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Current Role of Atherectomy for Treatment of Femoropopliteal and Infrapopliteal Disease

Cited by 7 publications

References 68 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

Prediction of restenosis based on hemodynamical markers in revascularized femoro-popliteal arteries during leg flexion

Percutaneous Revascularization of the Tibial Arteries

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