Lower Extremity Revascularization Using Optical Coherence Tomography–Guided Directional Atherectomy: Final Results of the EValuatIon of the PantheriS OptIcal COherence Tomography ImagiNg Atherectomy System for Use in the Peripheral Vasculature (VISION) Study

Schwindt, Arne; Bennett, Johannes; Crowder, William; Dohad, Suhail; Janzer, Sean; George, Jon C.; Tedder, Barry; Davis, Thomas P.; Cawich, Ian; Gammon, Roger S.; Muck, Patrick; Pigott, John P.; Dishmon, Dwight A.; Lopez, Lou A.; Golzar, Jaafer; Chamberlin, Jack R.; Moulton, Michael J.; Zakir, Ramzan M.; Kaki, Amir K.; Fishbein, Gary J.; McDaniel, Huey G.; Hezi-Yamit, Ayala; Simpson, John B.; Desai, Arjun

doi:10.1177/1526602817701720

Cited by 49 publications

(49 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Another interesting technology is directional atherectomy combined with optical coherence tomography, which allows more efficient debulking of the lesion while sparing adventitia. This technology is used in the Pantheris catheter, the safety and efficiency of which were confirmed in the Vision study [5].…”

Section: Discussionmentioning

confidence: 75%

“…Some devices use ultrasound waves for plaque modifications [4]. Novel devices are equipped with an intravascular imaging system such as optical coherence tomography (OCT) [5] or they use laser light to debulk the lesion [6]. The two atherectomy devices available on the market and used most frequently are the directional and rotational ones.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of long-term outcomes after directional versus rotational atherectomy in peripheral artery disease

Janas

Milewski

Buszman

et al. 2020

pwki

View full text Add to dashboard Cite

Introduction: The rate of atherectomy utilization in peripheral artery diseases (PAD) is growing. The two atherectomy devices available on the market and used most frequently are the directional and rotational ones. Nonetheless, there is a lack of direct comparison between these two types of atherectomy in PAD. Aim: To compare the long-term outcomes after PAD endovascular revascularization with two types of atherectomies: rotational (AR) (Phoenix Philips) and directional (AD) (SilverHawk Medtronic). Material and methods: This was a single-center, retrospective study of obstructive and symptomatic PAD patients who underwent revascularization with atherectomy. The endpoints were considered as target lesion revascularization (TLR), death, amputations and bailout stenting (BS). Results: The AR group consisted of 97 patients, while the AD group consisted of 85 individuals. There were no significant differences between the groups in terms of baseline characteristics except for an increased critical limb ischemia (CLI) prevalence in the AR group. The mean follow-up for AD and AR was 282.6 ±147.4 and 255.7 ±186.1 days, respectively (p = 0.44). There were no significant differences in the death rate (AD: 1 (1.7%) vs. AR: 5 (5.7%); p = 0.54), amputations (AD: 2 (2.3%) vs. AR: 5 (5.7%); p = 0.45) or bailout stenting (AD: 2 (2.3%) vs. AR: 3 (3.2%); p = 0.74), whereas TLR was more frequent in the AD group (AD: 25 (29%) vs. AR: 15 (15.9%; p = 0.03). The Kaplan-Meier analysis showed no significant differences between the groups in time to TLR, amputation or death. Conclusions: In this hypothesis-generating study the AR had a lower rate of TLR when compared to the AD. Nevertheless, this should be confirmed in further controlled randomized trials.

show abstract

Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Comparison of long-term outcomes after directional versus rotational atherectomy in peripheral artery disease

Janas

Milewski

Buszman

et al. 2020

pwki

View full text Add to dashboard Cite

show abstract

“…OCT-guided atherectomy has clinical benefits of tissue excision with minimal injury to healthy tissue, reduction in the use of contrast agents or radiation, and focused treatment following the identification of plaque distribution and morphology [31]. Schwindt et al [6] noted that OCT-guided directional atherectomy resulted in 62% of lesions being removed with no disruption or contact with adventitia and 82% of lesions having less than 1% adventitia in excised tissue, which may have contributed to the 92% freedom from target lesion revascularization rate noted at six months post-procedure. Nonradiation imaging such as OCT provides physicians as well as patients with an option of visualization of intravascular conditions with minimal or no contrast or radiation.…”

Section: Discussionmentioning

confidence: 99%

“…Intravascular imaging can therefore assist in the development or modification of a treatment strategies [4]. Such imaging has also shown utility in post-treatment assessments, which can result in increased treatment success and a reduction in patient morbidity [5,6].…”

Section: Introductionmentioning

confidence: 99%

A Post-market, Multi-vessel Evaluation of the Imaging of Peripheral Arteries for Diagnostic PurposeS Comparing Optical Coherence TomogrAphy and INtravascular Ultrasound Imaging (SCAN)

Pavillard

Sewell

2020

Preprint

View full text Add to dashboard Cite

Background: Intravascular imaging plays an important part in diagnosis of vascular conditions and providing insight for treatment strategy. Two main imaging modalities are intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The objective of this study was to prove non-inferiority of OCT imaging to IVUS images in matched segments of peripheral vessels in patients with suspected peripheral vascular disease. Methods: The SCAN study was a prospective, non-inferiority clinical study of matched IVUS and OCT images collected along defined segments of peripheral vessels from twelve subjects (mean age 68 10.3 years; 10 men) displaying symptoms of vascular disease. Luminal diameters were measured by both imaging systems at the distal, middle, and proximal points of the defined segments. Three blinded interventional radiologists evaluated the quality of both imaging modalities in identifying lMann-Whitney-Wilcoxon testing. Intrareader reproducibility was calculated by intraclass correlation (ICC) analysis. Results: The mean scoringof plaque, calcification, and vascular stent struts by the three readers was significant better in terms of image quality for OCT than IVUS (p<0.001, p=0.001, p=0.004, respectively). The mean scores of vessel wall component visibility and artifacts generated by the two imaging systems were not significantly different (p=0.19, p=0.07, respectively). Mean vessel luminal diameter and area at three specific locations within the vessels were not significantly different between the two imaging modalities. No patient injury, adverse effect or device malfunction were noted during thestudy. Conclusions: Imaging byOCT provides the physician with better visualization of some vessel and plaque chacteristics, but both IVUS and OCT imaging are safe and effective methods of examining peripheral vessels in order to perform diagnostic assessment of peripheral vessels and provide information necessary for the treatment strategy of peripheral artery disease.

show abstract

“…The authors noted a low rate of stenting (10%) and a very high patency rate of 97% at the follow-up investigation after where a technical success rate of 97% was achieved with a diameter stenosis reduction from 78.7% at baseline to 30.3% after atherectomy alone and with a low rate of peri-procedural complications, such as perforation (0%), catheter-related dissection (0.5%) and embolisation (2%). 21 Figure 2 illustrates a flush total occlusion of the heavily calcified proximal right superficial femoral artery (SFA), which was successfully tackled after intraluminal retrograde passage of the lesion.…”

Section: Directional Atherectomymentioning

confidence: 99%

The Role of Atherectomy in Peripheral Artery Disease: Current Evidence and Future Perspectives

Korosoglou¹,

Giuşcă²,

Andrassy³

et al. 2019

Vascular and Endovascular Review

View full text Add to dashboard Cite

The prevalence of peripheral artery disease (PAD) has been rising consistently over the past few decades, along with increasing rates of type 2 diabetes. More than 200 million people are estimated to be affected by PAD worldwide. 1 Despite aggressive modifications of lifestyle and risk factors, and advances in the pharmacological management of patients with PAD using antiplatelet agents, statins, cilostazol, angiotensin-converting enzyme inhibitors, angiotensinreceptor blockers and low-dose anticoagulation with rivaroxaban, patients with PAD frequently require invasive procedures to improve the symptoms of claudication and prevent tissue damage or loss in those with critical limb ischaemia (CLI). 2 Due to recent technological advances in materials and devices for the endovascular treatment of PAD, a minimally invasive percutaneous approach is considered a first-choice strategy for the treatment of symptomatic patients and is given preference over older surgical options. According to current guidelines, endovascular therapy is the most favoured option for infrainguinal stenotic or occlusive lesions <25 cm, whereas open surgery may be associated with better longterm patency, especially when using saphenous vein grafts in patients with long occlusive lesions (>25 cm) that cross the knee. 3 Commonly used techniques include plain balloon angioplasty, drug-coated balloon (DCB) angioplasty, bare metal stents, drug-eluting stents and stent grafts for vessel perforation. Such endovascular approaches have been successfully used to alleviate symptoms in patients with claudication and have been associated with limb salvage in patients with CLI. [4][5][6] In many cases, such 'basic' approaches may be compromised by severe calcification. Calcification may be the reason for a poor primary outcome due to early recoil or extensive flow-limiting dissections after high-pressure angioplasty, culminating in the need for bailout stent placement. 7 Despite the most recent self-expandable nitinol stent technology, rates of re-stenosis may be high, resulting in primary patency rates of <50% for bare metal stents and <70% for drug-eluting stents at 5-year follow-up. 8 Even with dedicated stent devices, stent fractures may occur at sites of extensive movement and flexion as in the popliteal artery, resulting in stent thrombosis and subsequent occlusion. 9 With conventional open surgery, 5-year patency rates of more than 80% have been reported with saphenous vein grafts compared with 67% when using prosthetic conduits. 10 Although no randomised trials are currently available for a head-to-head comparison of endovascular versus surgical treatment for long and calcified femoropopliteal lesions, AbstractAn ageing population and the increasing prevalence of cardiovascular risk factors have aggravated the burden of peripheral artery disease (PAD). Despite advances in the pharmacological treatment of atherosclerosis, many patients with symptomatic PAD require invasive procedures to reduce the symptoms of claudication, salvage tissue and prevent a...

show abstract

Lower Extremity Revascularization Using Optical Coherence Tomography–Guided Directional Atherectomy: Final Results of the EValuatIon of the PantheriS OptIcal COherence Tomography ImagiNg Atherectomy System for Use in the Peripheral Vasculature (VISION) Study

Abstract: OCT-guided atherectomy for femoropopliteal disease is safe and effective. Additionally, the precision afforded by OCT guidance leads to greater removal of plaque during atherectomy while sparing the adventitia.

Cited by 49 publications

References 23 publications

Comparison of long-term outcomes after directional versus rotational atherectomy in peripheral artery disease

Comparison of long-term outcomes after directional versus rotational atherectomy in peripheral artery disease

A Post-market, Multi-vessel Evaluation of the Imaging of Peripheral Arteries for Diagnostic PurposeS Comparing Optical Coherence TomogrAphy and INtravascular Ultrasound Imaging (SCAN)

The Role of Atherectomy in Peripheral Artery Disease: Current Evidence and Future Perspectives

Contact Info

Product

Resources

About