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Current Cardiology Reports

Erschienen in:

10.05.2022 | Peripheral Vascular Disease (WS Jones, Section Editor)

Atherectomy vs Other Modalities for Treatment During Peripheral Vascular Intervention

verfasst von: Mohsin Chowdhury, Eric A. Secemsky

Erschienen in: Current Cardiology Reports | Ausgabe 7/2022

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Abstract

Purpose of the Review

Calcified atheroma is frequently encountered in peripheral vascular intervention. Standard treatment with balloon and/or stenting alone does poorly in these cases due to vessel recoil, suboptimal luminal gain, and inadequate stent expansion. In light of the above challenges with angioplasty and stenting for PAD, endovascular atherectomy has emerged as a novel technology for atheroma treatment and removal, offering the benefits of surgical endarterectomy in a minimally invasive percutaneous approach. This review outlines the endovascular atherectomy devices available in clinical practice to date, compares and contrasts their mode of action, summarizes the relevant published data on indication and role of atherectomy over other treatment modalities for PAD, and discusses the future prospective on this emerging technology.

Recent Findings

Currently, there are host of peripheral atherectomy devices available with unique mechanism of action and relative advantages and disadvantages. Despite these recent technological advancements, there remains a paucity of data from well-designed studies regarding the superiority of atherectomy as an adjunctive treatment versus standard treatment with balloon and stenting. Emerging data have supported its use to improve patency rates in conjunction with drug-coated balloons. Although associated risks, including distal embolization and perforation, are often marginal, the cost of these devices to the healthcare system necessitates further investment in to establishing level 1 data to support their use.

Summary

Peripheral atherectomy has the potential to improve limb-related outcomes, potentially through reduced need for bail-out scaffolds and improved drug uptake. Nonetheless, further investment in the evidence foundation supporting these devices versus standard practices is required.

Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286(11):1317–24. https://doi.org/10.1001/jama.286.11.1317.CrossRefPubMed

Marrett E, DiBonaventura M, Zhang Q. Burden of peripheral arterial disease in Europe and the United States: a patient survey. Health Qual Life Outcomes. 2013;11:175. https://doi.org/10.1186/1477-7525-11-175.CrossRefPubMedPubMedCentral

Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382(9901):1329–40. https://doi.org/10.1016/S0140-6736(13)61249-0.CrossRefPubMed

Scully RE, Arnaoutakis DJ, DeBord SA, Semel M, Nguyen LL. Estimated annual health care expenditures in individuals with peripheral arterial disease. J Vasc Surg. 2018;67(2):558–67. https://doi.org/10.1016/j.jvs.2017.06.102.CrossRefPubMed

•• Fowkes FG, Aboyans V, Fowkes FJ, McDermott MM, Sampson UK, Criqui MH. Peripheral artery disease: epidemiology and global perspectives. Nat Rev Cardiol. 2017;14(3):156–70. https://doi.org/10.1038/nrcardio.2016.179. This is an excellent review article that examines the global epidemiology of PAD and highlights the global gender and socioeconomic disparities in diagnosis and management of PAD.CrossRefPubMed

McDermott MM, Greenland P, Liu K, Guralnik JM, Criqui MH, Dolan NC, et al. Leg symptoms in peripheral arterial disease: associated clinical characteristics and functional impairment. JAMA. 2001;286(13):1599–606. https://doi.org/10.1001/jama.286.13.1599.CrossRefPubMed

Soga Y, Iida O, Takahara M, Hirano K, Suzuki K, Kawasaki D, et al. Two-year life expectancy in patients with critical limb ischemia. JACC Cardiovasc Interv. 2014;7(12):1444–9. https://doi.org/10.1016/j.jcin.2014.06.018.CrossRefPubMed

Soden PA, Zettervall SL, Curran T, Vouyouka AG, Goodney PP, Mills JL, et al. Regional variation in patient selection and treatment for lower extremity vascular disease in the vascular quality initiative. J Vasc Surg. 2017;65(1):108–18. https://doi.org/10.1016/j.jvs.2016.06.105.CrossRefPubMed

Mittleider D, Russell E. Peripheral atherectomy: applications and techniques. Tech Vasc Interv Radiol. 2016;19(2):123–35. https://doi.org/10.1053/j.tvir.2016.04.005.CrossRefPubMed

10.

McKinsey JF, Zeller T, Rocha-Singh KJ, Jaff MR, Garcia LA, Investigators DL. Lower extremity revascularization using directional atherectomy: 12-month prospective results of the DEFINITIVE LE study. JACC Cardiovasc Interv. 2014;7(8):923–33. https://doi.org/10.1016/j.jcin.2014.05.006.CrossRefPubMed

11.

Akkus NI, Abdulbaki A, Jimenez E, Tandon N. Atherectomy devices: technology update. Med Devices (Auckl). 2015;8:1–10. https://doi.org/10.2147/MDER.S50594.CrossRef

12.

Roberts D, Niazi K, Miller W, Krishnan P, Gammon R, Schreiber T, et al. Effective endovascular treatment of calcified femoropopliteal disease with directional atherectomy and distal embolic protection: final results of the DEFINITIVE Ca(+)(+) trial. Catheter Cardiovasc Interv. 2014;84(2):236–44. https://doi.org/10.1002/ccd.25384.CrossRefPubMed

13.

Ramaiah V, Gammon R, Kiesz S, Cardenas J, Runyon JP, Fail P, et al. Midterm outcomes from the TALON Registry: treating peripherals with SilverHawk: outcomes collection. J Endovasc Ther. 2006;13(5):592–602. https://doi.org/10.1583/05-1780MR.1.CrossRefPubMed

14.

Medtronic Inc. Recalls HawkOne Directional Atherectomy System due to risk of tip damage during use. United States Food and Drug Administration, https://www.fda.gov/medical-devices/medical-device-recalls/medtronic-inc-recalls-hawkone-directional-atherectomy-system-due-risk-tip-damage-during-use#:~:text=Recalls%20HawkOne%20Directional%20Atherectomy%20System%20Due%20to%20Risk%20of%20Tip%20Damage%20During%20Use,-Share&text=The%20FDA%20has%20identified%20this,cause%20serious%20injuries%20or%20death. 2022. (Accessed 30 Jan 2022).

15.

Cawich I, Paixao AR, Marmagkiolis K, Lendel V, Rodriguez-Araujo G, Rollefson WA, et al. Immediate and intermediate-term results of optical coherence tomography guided atherectomy in the treatment of peripheral arterial disease: initial results from the VISION trial. Cardiovasc Revasc Med. 2016;17(7):463–7. https://doi.org/10.1016/j.carrev.2016.07.002.CrossRefPubMed

16.

Brodmann M, Werner M, Holden A, Tepe G, Scheinert D, Schwindt A, et al. Primary outcomes and mechanism of action of intravascular lithotripsy in calcified, femoropopliteal lesions: results of disrupt PAD II. Catheter Cardiovasc Interv. 2019;93(2):335–42. https://doi.org/10.1002/ccd.27943.CrossRefPubMed

17.

• Adams G, Shammas N, Mangalmurti S, Bernardo NL, Miller WE, Soukas PA, et al. Intravascular lithotripsy for treatment of calcified lower extremity arterial stenosis: initial analysis of the disrupt PAD III study. J Endovasc Ther. 2020;27(3):473–80. https://doi.org/10.1177/1526602820914598. This is a real world study that demonstarted safety and efficacy of intravascular lithotripsy (IVL) in treatment of severly calcified PAD.CrossRefPubMed

18.

Tepe G, Brodmann M, Werner M, Bachinsky W, Holden A, Zeller T, et al. Intravascular lithotripsy for peripheral artery calcification: 30-day outcomes from the randomized disrupt PAD III trial. JACC Cardiovasc Interv. 2021;14(12):1352–61. https://doi.org/10.1016/j.jcin.2021.04.010.CrossRefPubMed

19.

Brodmann M, Holden A, Zeller T. Safety and feasibility of intravascular lithotripsy for treatment of below-the-knee arterial stenoses. J Endovasc Ther. 2018;25(4):499–503. https://doi.org/10.1177/1526602818783989.CrossRefPubMed

20.

Rundback J, Chandra P, Brodmann M, Weinstock B, Sedillo G, Cawich I, et al. Novel laser-based catheter for peripheral atherectomy: 6-month results from the Eximo Medical B-Laser IDE study. Catheter Cardiovasc Interv. 2019;94(7):1010–7. https://doi.org/10.1002/ccd.28435.CrossRefPubMed

21.

Grundfest WS, Litvack F, Forrester JS, Goldenberg T, Swan HJ, Morgenstern L, et al. Laser ablation of human atherosclerotic plaque without adjacent tissue injury. J Am Coll Cardiol. 1985;5(4):929–33. https://doi.org/10.1016/s0735-1097(85)80435-6.CrossRefPubMed

22.

Zeller T, Krankenberg H, Steinkamp H, Rastan A, Sixt S, Schmidt A, et al. One-year outcome of percutaneous rotational atherectomy with aspiration in infrainguinal peripheral arterial occlusive disease: the multicenter pathway PVD trial. J Endovasc Ther. 2009;16(6):653–62. https://doi.org/10.1583/09-2826.1.CrossRefPubMed

23.

Davis T, Ramaiah V, Niazi K, Martin Gissler H, Crabtree T. Safety and effectiveness of the Phoenix Atherectomy System in lower extremity arteries: early and midterm outcomes from the prospective multicenter EASE study. Vascular. 2017;25(6):563–75. https://doi.org/10.1177/1708538117712383.CrossRefPubMedPubMedCentral

24.

Freitas B, Steiner S, Bausback Y, Branzan D, Ulrich M, Braunlich S, et al. Rotarex mechanical debulking in acute and subacute arterial lesions. Angiology. 2017;68(3):233–41. https://doi.org/10.1177/0003319716646682.CrossRefPubMed

25.

Safian RD, Niazi K, Runyon JP, Dulas D, Weinstock B, Ramaiah V, et al. Orbital atherectomy for infrapopliteal disease: device concept and outcome data for the OASIS trial. Catheter Cardiovasc Interv. 2009;73(3):406–12. https://doi.org/10.1002/ccd.21898.CrossRefPubMed

26.

Dattilo R, Himmelstein SI, Cuff RF. The COMPLIANCE 360 degrees trial: a randomized, prospective, multicenter, pilot study comparing acute and long-term results of orbital atherectomy to balloon angioplasty for calcified femoropopliteal disease. J Invasive Cardiol. 2014;26(8):355–60.PubMed

27.

Shammas NW, Lam R, Mustapha J, Ellichman J, Aggarwala G, Rivera E, et al. Comparison of orbital atherectomy plus balloon angioplasty vs. balloon angioplasty alone in patients with critical limb ischemia: results of the CALCIUM 360 randomized pilot trial. J Endovasc Ther. 2012;19(4):480–8. https://doi.org/10.1583/JEVT-12-3815MR.1.

28.

Laird JR, Zeller T, Gray BH, Scheinert D, Vranic M, Reiser C, et al. Limb salvage following laser-assisted angioplasty for critical limb ischemia: results of the LACI multicenter trial. J Endovasc Ther. 2006;13(1):1–11. https://doi.org/10.1583/05-1674.1.CrossRefPubMed

29.

Laird J, Joye J, Sachdev N, Huang P, Caputo R, Mohiuddin I, et al. Recanalization of infrainguinal chronic total occlusions with the crosser system: results of the PATRIOT trial. J Invasive Cardiol. 2014;26(10):497–504.PubMed

30.

Diamantopoulos A, Katsanos K. Atherectomy of the femoropopliteal artery: a systematic review and meta-analysis of randomized controlled trials. J Cardiovasc Surg (Torino). 2014;55(5):655–65.

31.

• Lin F, Wang H, Ding W, Chen G, Zhang Z. Atherectomy plus drug-coated balloon versus drug-coated balloon only for treatment of femoropopliteal artery lesions: a systematic review and meta-analysis. Vascular. 2021;29(6):883–96. https://doi.org/10.1177/1708538120985732. This metaanalysis examined the safety and efficacy of combination of atherectomy and drug-coated balloon as compared to drug-coated balloon only in treatment of femoropopliteal PAD.CrossRefPubMed

32.

Shammas NW, Dippel EJ, Coiner D, Shammas GA, Jerin M, Kumar A. Preventing lower extremity distal embolization using embolic filter protection: results of the PROTECT registry. J Endovasc Ther. 2008;15(3):270–6. https://doi.org/10.1583/08-2397.1.CrossRefPubMed

Titel: Atherectomy vs Other Modalities for Treatment During Peripheral Vascular Intervention
verfasst von: Mohsin Chowdhury
Eric A. Secemsky
Publikationsdatum: 10.05.2022
Verlag: Springer US
Erschienen in: Current Cardiology Reports / Ausgabe 7/2022
Print ISSN: 1523-3782
Elektronische ISSN: 1534-3170
DOI: https://doi.org/10.1007/s11886-022-01709-1

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Abstract

Purpose of the Review

Recent Findings

Summary

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