Phoenix atherectomy for patients with peripheral artery disease

Giuşcă, Sorin; Hagstotz, Saskia; Lichtenberg, Michael; Heinrich, Ulrike; Eisenbach, Christoph; Andrassy, Martin; Korosoglou, Grigorios

doi:10.4244/eij-d-21-01070

Cited by 20 publications

(6 citation statements)

References 31 publications

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“…Since POBA or DCB angioplasty work by pressing the atheromatic material to the arterial wall, it is quite logical to expect that these endovascular techniques would benefit from prior compression of the plaques. In this regard, since becoming commercially available, rotational atherectomy for the treatment of PAD has demonstrated both safety and efficacy [ 8 , 11 , 19 ] in the femoropopliteal segment [ 19 , 20 , 21 , 22 ]. However, considering the BTK vessels, the evidence and published data are still scarce and industry-sponsored.…”

Section: Discussionmentioning

confidence: 99%

“…In the last decades, the endovascular treatment with plain old balloon angioplasty (POBA) has been established as a first line-treatment for CLTI patients with short stenotic lesions and occlusions in the infra-popliteal segment [ 7 ]. Since then, different atherectomy devices have been developed, proving their applicability in the femoropopliteal segment and even the common femoral artery (CFA) [ 8 , 9 ]. However, no robust conclusion can be drawn due to the plethora of atherectomy types and the absence of control groups.…”

Section: Introductionmentioning

confidence: 99%

“…A recent study from Taneva et al showed promising mid-term results for the use of rotational atherectomy assisted angioplasty in the treatment of femoropopliteal lesions with a primary patency rate of 97% at 12 months and 87% at 24 months [ 10 ]. However, the available data on the utilization of atherectomy in the infra-popliteal segment, specifically within the below-the-knee vessels, is notably limited [ 8 , 11 ]. Kumarasamy et al [ 11 ] showed that rotational atherectomy for the treatment of BTK-lesions is feasible but did not provide any direct comparison with other endovascular techniques.…”

Section: Introductionmentioning

confidence: 99%

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Use of Rotational Atherectomy-Assisted Balloon Angioplasty in the Treatment of Isolated Below-the-Knee Atherosclerotic Lesions in Patients with Chronic Limb-Threatening Ischemia

Pitoulias,

Taneva,

Avranas

et al. 2024

JCM

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The aim of the study is to evaluate the safety and effectiveness of rotational atherectomy-assisted balloon angioplasty (BTK-RA) for the treatment of isolated below the knee (BTK) atherosclerotic lesions and to compare the outcomes to plain old balloon angioplasty (POBA). Between January 2020 and September 2023, 96 consecutive patients with chronic limb threatening ischemia (CTLI) and isolated BTK-lesions underwent POBA (group A) or BTK-RA (group B). The primary outcome measures were: periprocedural technical success, primary patency, postoperative increase of the ankle branchial index (ABI), target lesion revascularization (TLR), limb salvage, minor amputation and death. Both techniques had similar technical success, operative time, intraprocedural complications and bailout stent implantations, independently of the operator’s experience. Group B had significantly higher primary patency rates (93.5% vs. 72.0%, respectively, p = 0.006), TLR (2.1% vs. 24%, p = 0.057), lower in-hospital stay (2.0–3.0 vs. 4.0–6.0 days, respectively, p < 0.001) and higher postoperative ABI (0.8–0.2 vs. 0.7–0.1, respectively, p = 0.008), compared to group A. Significant differences (POBA n: 20, 40%, BTK-RA n = 3, 6.5%) were found in minor amputation rates between the two groups (p < 0.001), while the respective limb salvage rates were similar in both groups (94.0% vs. 97.8%, p = 0.35). The use of BTK-RA for the treatment of BTK-lesions in patients with CTLI showed significant clinical advantages in comparison to POBA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Use of Rotational Atherectomy-Assisted Balloon Angioplasty in the Treatment of Isolated Below-the-Knee Atherosclerotic Lesions in Patients with Chronic Limb-Threatening Ischemia

Pitoulias,

Taneva,

Avranas

et al. 2024

JCM

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“…Shammas et al indicated that the OA + BA arm had significantly lower 12-month all-cause mortality than the BA arm in the treatment of IPOD (24). Of course, several non-randomized studies have also demonstrated the utility of ADs for IPOD patients, including rotational and laser atherectomy (39)(40)(41)(42). On the other hand, there is a view that vessel preparation with ADs achieves high technical success of endovascular treatment by increasing the risk of perioperative distal embolization (43).…”

Section: -M Primary Patency 12-m Primary Patency 6-m Tlr 12-m Tlr 12-...mentioning

confidence: 99%

The efficacy and safety of different endovascular modalities for infrapopliteal arteries lesions: A network meta-analysis of randomized controlled trials

Guo¹,

Ning²,

Wang³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundEndovascular treatment has become the first-line therapy for infrapopliteal artery occlusive disease (IPOD), while the optimal endovascular method remains to be determined. We performed a network meta-analysis (NWM) of randomized controlled trials (RCTs) to simultaneously compare the outcomes of different endovascular modalities for IPOD.Methods and resultsThe Pubmed, Embase, and Cochrane databases were used as data sources. The NWM approach used random-effects models based on the frequentist framework. In total, 22 eligible RCTs (44 study arms; 1,348 patients) involving nine endovascular modalities or combinations [balloon angioplasty (BA), drug-coated balloon (DCB), drug-eluting stent (DES), atherectomy device + BA (AD + BA), AD + DCB, balloon-expandable bare metal stent (BMS), self-expanding stent (SES), absorbable metal stents (AMS), and inorganics-coated stent (ICS)] were included. BA had a lower 12-month primary patency rate than DCB (RR 0.50, CI 0.27, 0.93) and AD + DCB (RR 0.34, CI 0.12, 0.93). AD + DCB decreased 6-month TLR compared with AMS (RR 0.15, CI 0.03, 0.90), and DES decreased it compared with BMS (RR 0.25, CI 0.09, 0.71). DCB had a lower 6-month TLR rate than AMS (RR 0.26, CI 0.08, 0.86) and BA (RR 0.51, CI 0.30, 0.89). BA had a higher 12-month TLR rate than DCB (RR 1.76, CI 1.07, 2.90). According to the value of the surface under the cumulative ranking curve (SUCRA), AD + DCB was considered the best treatment in terms of primary patency at 6 months (SUCRA = 87.5) and 12 months (SURCA = 91). AD + BA was considered the best treatment in terms of 6-month TLR (SUCRA = 83.1), 12-month TLR (SURCA = 75.8), and 12-month all-cause mortality (SUCRA = 92.5). In terms of 12-month major amputation, DES was considered the best treatment (SUCRA = 78.6), while AD + DCB was considered the worst treatment (SUCRA = 28.8). Moreover, AD + BA always ranks higher than AD + DCB in the comparison including these two combinations. Subgroup analyses of modalities without stenting did not significantly change the primary outcomes.ConclusionADs showed noteworthy advantages in multiple terms for IPOD except for 12-month major amputation. AD + BA may be a better method for IPOD than AD + DCB. The efficacy and safety of ADs are worthy of further investigation.Systematic review registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42022331626].

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“…Recent studies have shown that rotational atherectomy can be beneficial for the treatment of severe PAD even in fine and small-calibre below-the-knee (BTK) arteries, with promising results and with low rates of bailout stenting as well as target lesion revascularisation (TLR) [ 8 , 9 ]. Additionally, Pitoulias et al compared the early results of plain old balloon angioplasty (POBA) and atherectomy-assisted angioplasty in chronic limb-threatening ischemia (CLTI) and showed favourable outcomes with lower amputation rates and higher primary patency for the atherectomy interventions [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Sex-Specific Analysis of Mid-Term Outcomes of Atherectomy-Assisted Endovascular Treatment in Severe Peripheral Arterial Disease

Avranas,

Pitoulias,

Taneva

et al. 2024

JCM

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Background: Endovascular treatment of lower-extremity peripheral disease (PAD) is associated with higher complication rates and suboptimal outcomes in women. Atherectomy has shown favourable outcomes in calcified lesions, minimising the incidence of stent placement caused by recoil or flow-limiting dissection. To date, there are no published mid-term outcomes evaluating the performance of atherectomy differentiated by sex. This study aims to evaluate sex-specific outcomes and prognostic factors affecting the results of atherectomy-assisted endovascular treatment in severe PAD. Methods: A retrospective analysis was conducted at a single centre in Germany, initiated by physicians and not sponsored by industry, on patients presenting with Rutherford categories ranging from III to V and featuring de novo occlusive or stenotic lesions of the superficial femoral (SFA) and/or popliteal arteries. The intervention involved rotational atherectomy-assisted angioplasty utilising the Jetstream (Boston, US®) device. The point of interest of this study was postinterventional clinical improvement as well as mid-term outcomes, including primary patency, over a targeted 2-year follow-up period. Statistical analysis utilised Cox regression (survival analysis) to calculate hazard ratios according to sex category. Comparative survival analysis was performed using the log-rank test and visually represented through Kaplan–Meier curves. Risk factors associated with absence of clinical improvement were examined across both sex groups utilising the chi-square or Fisher exact test, as appropriate. Results: A total of 98 patients (103 limbs) were initially included, with >75% having moderate-to-severe lesion calcification (>50%). A total of 84 patients (97 limbs, 62 male and 35 female) proceeded to a 2-year follow-up (mean 16.4 months for males and 16.1 for females) after a successful index procedure. Age distribution, Rutherford class, diabetes, chronic kidney disease (CKD), target vessel, lesion type, and length were balanced among both groups. Similar primary patency rates, of 89% among female and 91% among male limbs, were observed (p = 0.471). Female patients exhibited a lower rate of clinical improvement based on the Rutherford scale in comparison to males (80.6% vs. 94.5%, p = 0.048). CDK was the only significant prognostic factor across pooled data (odds ratio for CKD: 15.15, p < 0.001). Conclusions: Rotational atherectomy showed comparably high rates of mid-term primary patency, with low rates of bailout stent placement. These findings highlight the beneficial use of atherectomy in female patients who are per se at risk for higher rates of complications during and after endovascular interventions.

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Phoenix atherectomy for patients with peripheral artery disease

Cited by 20 publications

References 31 publications

Use of Rotational Atherectomy-Assisted Balloon Angioplasty in the Treatment of Isolated Below-the-Knee Atherosclerotic Lesions in Patients with Chronic Limb-Threatening Ischemia

Use of Rotational Atherectomy-Assisted Balloon Angioplasty in the Treatment of Isolated Below-the-Knee Atherosclerotic Lesions in Patients with Chronic Limb-Threatening Ischemia

The efficacy and safety of different endovascular modalities for infrapopliteal arteries lesions: A network meta-analysis of randomized controlled trials

Sex-Specific Analysis of Mid-Term Outcomes of Atherectomy-Assisted Endovascular Treatment in Severe Peripheral Arterial Disease

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