Peripheral Atherectomy: A Critical Review

Abstract

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.

Application of rotational atherectomy for a calcified superficial femoral artery lesion

“…However, in recent years, a variety of new techniques and devices have become available [7][8][9][10][11][12][13]. The usefulness of high speed rotational atherectomy for calcified lesions is well known and can also be applied to peripheral arteries [14][15][16][17][18]. Atherectomy of the calcified lesion by Rotablator (Boston Scientific, Natick, MA, USA) can facilitate easy balloon crossing, balloon dilatation, and subsequent stenting.…”

Using the modern Silverhawk™ atherectomy catheter to characterize biliary structures that appear malignant: review of initial experience

“…Since its approval in 1990 by the US Food and Drug Administration (FDA) for directional coronary plaque excision, numerous improvements in catheter design have followed, 13 culminating in the present‐day Silverhawk™ SXL plaque excision system (FoxHollow Technologies, Inc., Redwood City, CA, USA). This device was approved by the FDA in 2007, and is now the leading directional atherectomy catheter on the market 14 . Lacking an apposition balloon, the Silverhawk™ device self‐apposes using a hinge system, contains a carbide cutter with variable height, and can rotate at speeds of up to 8000 rpm.…”

“…Additionally, the hinged nose cone can act as a large depository for intraluminal contents, with collection occurring distally to the cutting mechanism. Using this, the operator can decide the extent of the application and the large chamber size can facilitate its application over longer distances 14 . These improvements not only make the device more attractive in the coronary and peripheral vascular arenas, but also offer theoretical advantages in hepatobiliary applications.…”