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Atherectomy reduces incident amputation in certain patients with CLI

SAN DIEGO — Patients with critical limb ischemia from occlusive tibioperoneal arterial disease who underwent atherectomy had lower rates of incident amputation compared with those who underwent balloon angioplasty, according to data presented at TCT 2018.

Payal Sharma, MD, resident in the department of internal medicine at Aurora Sinai/Aurora St. Luke’s Medical Centers in Milwaukee, and colleagues analyzed data from 2,908 patients (mean age, 69 years; mean occluded length, 6.9 cm) from the multicenter PVI Registry who had isolated endovascular intervention of tibial and peroneal arteries for occlusive disease. Patients either underwent atherectomy (n = 1,454; 2,183 arteries; 29% women) or balloon angioplasty (n = 1,454; 2,141 arteries; 29% women).

Patients were followed up for a median of 507 days.

The atherectomy group had a lower rate of amputation vs. the angioplasty group (6.2% vs. 8.3%; P = .01) and were less likely to need bailout stenting (4.5% vs. 6.3%; OR = 0.7; 95% CI, 0.53-0.92). Minor amputations (3% vs. 4.1%; P = .08) contributed to this difference.

Patients treated with atherectomy had higher procedural technical success compared with those treated with balloon angioplasty (92.9% vs. 91%; P = .02).

“Procedural technical success was defined as patent vessel with a burst of flow at the end of the intervention with residual stenosis of less than 30% and less than 10 mm Hg pressure gradient,” Sharma said during the presentation.

The atherectomy and angioplasty groups had similar rates of vessel patency at 6 months (66% vs. 63.5%, respectively; P = .35).

During the procedure, the atherectomy and angioplasty groups had no significant differences in the rates of perforation (1.3% vs. 0.6%, respectively; P = .06), vessel dissection (2.3% vs. 2.5%, respectively; P = .67) or distal embolization (1.2% vs. 1.1%, respectively; P = .73).

Patients treated with atherectomy had higher contrast use and fluoroscopy time vs. those treated with angioplasty.

“With the multitude of atherectomy systems available, more studies need to be done in order to identify the most effective devices for clinical situations where tibioperoneal disease leads to critical limb ischemia,” Sharma said. – by Darlene Dobkowski

Reference:

Sharma P, et al. Abstract 113. Presented at: TCT Scientific Symposium; Sept. 21-25, 2018; San Diego.

Sharma P, et al. J Am Coll Cardiol. 2018;doi:10.1016/j.jacc.2018.08.1215.

Disclosure: Sharma reports no relevant financial disclosures.

SAN DIEGO — Patients with critical limb ischemia from occlusive tibioperoneal arterial disease who underwent atherectomy had lower rates of incident amputation compared with those who underwent balloon angioplasty, according to data presented at TCT 2018.

Payal Sharma, MD, resident in the department of internal medicine at Aurora Sinai/Aurora St. Luke’s Medical Centers in Milwaukee, and colleagues analyzed data from 2,908 patients (mean age, 69 years; mean occluded length, 6.9 cm) from the multicenter PVI Registry who had isolated endovascular intervention of tibial and peroneal arteries for occlusive disease. Patients either underwent atherectomy (n = 1,454; 2,183 arteries; 29% women) or balloon angioplasty (n = 1,454; 2,141 arteries; 29% women).

Patients were followed up for a median of 507 days.

The atherectomy group had a lower rate of amputation vs. the angioplasty group (6.2% vs. 8.3%; P = .01) and were less likely to need bailout stenting (4.5% vs. 6.3%; OR = 0.7; 95% CI, 0.53-0.92). Minor amputations (3% vs. 4.1%; P = .08) contributed to this difference.

Patients treated with atherectomy had higher procedural technical success compared with those treated with balloon angioplasty (92.9% vs. 91%; P = .02).

“Procedural technical success was defined as patent vessel with a burst of flow at the end of the intervention with residual stenosis of less than 30% and less than 10 mm Hg pressure gradient,” Sharma said during the presentation.

The atherectomy and angioplasty groups had similar rates of vessel patency at 6 months (66% vs. 63.5%, respectively; P = .35).

During the procedure, the atherectomy and angioplasty groups had no significant differences in the rates of perforation (1.3% vs. 0.6%, respectively; P = .06), vessel dissection (2.3% vs. 2.5%, respectively; P = .67) or distal embolization (1.2% vs. 1.1%, respectively; P = .73).

Patients treated with atherectomy had higher contrast use and fluoroscopy time vs. those treated with angioplasty.

“With the multitude of atherectomy systems available, more studies need to be done in order to identify the most effective devices for clinical situations where tibioperoneal disease leads to critical limb ischemia,” Sharma said. – by Darlene Dobkowski

Reference:

Sharma P, et al. Abstract 113. Presented at: TCT Scientific Symposium; Sept. 21-25, 2018; San Diego.

Sharma P, et al. J Am Coll Cardiol. 2018;doi:10.1016/j.jacc.2018.08.1215.

Disclosure: Sharma reports no relevant financial disclosures.

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