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Atherectomy successful in PAD; patency rates similar among device types

SAN DIEGO — Patients with occlusive lower extremity peripheral artery disease treated with atherectomy devices had over 96% procedural success, according to data presented at TCT 2018.

When the researchers compared results by atherectomy device type, excisional atherectomy was associated with higher rates of vessel dissection and perforation and lower amputation rates compared with laser or orbital atherectomy, although long-term vessel patency was similar in all groups.

Tonga Nfor, MD, cardiologist at Aurora Cardiovascular Services at Aurora Sinai/Aurora St. Luke’s Medical Centers at University of Wisconsin School of Medicine and Public Health in Milwaukee, and colleagues analyzed data from 9,814 patients in the multicenter PVI Registry who underwent atherectomy for the treatment of occlusive disease of infrainguinal arteries. Patients were categorized by atherectomy type: laser (n = 1,577; mean age, 68 years; 42% women), orbital (n = 5,140; mean age, 69 years; 38% women) and excisional (n = 3,097; mean age, 69 years; 42% women).

“If we had a device and we had clear anatomic definition of where the device was used, how it was used and why it was used, all of those patients were included in this study,” Nfor said during the presentation.

Follow-up was conducted for a median of 380 days.

Although all atherectomy devices achieved 96% procedural success, it was highest in patients treated with excisional atherectomy vs. those treated with orbital or laser atherectomy (98.8% vs. 96.7% vs. 97.8%, respectively; P < .001).

“This has been a selling point of these [atherectomy] devices from the companies, that it makes the procedure easier, as you can tell from the very high procedural success rates, all in the very high 90s,” Nfor said during the presentation.

The excisional atherectomy group had higher rates of vessel perforation compared with orbital or laser atherectomy (1.5% vs. 0.7% vs. 0.6%, respectively; P < .001). Patients treated with laser atherectomy had higher rates of stent use compared with excisional and orbital atherectomy (34% vs. 26.4% vs. 20.6%, respectively; P < .001).

“The use of stents would depend on what vascular territory you are working in,” Nfor said. “If you worked in the femoropopliteal territory, the need for stenting is usually higher, with about 30% of those patients needing stenting in the femoropopliteal territory. With patients that laser atherectomy, they had higher rates of bailout stenting as compared to orbital and excisional atherectomy.”

Primary patency rates did not differ between atherectomy devices at 6 months (P = .47) or at 12 months (P = .81).

Rates of target limb amputation were lowest in patients treated with excisional atherectomy compared with orbital or laser atherectomy (2.3% vs. 3.1% vs. 3.7%, respectively; P = .01).

“Choice of device should mainly be driven by operator experience and local availability,” Nfor said. – by Darlene Dobkowski

References:

Nfor T, et al. Abstract 114. Presented at: TCT Scientific Symposium; Sept. 21-25, 2018; San Diego.
Nfor T, et al. J Am Coll Cardiol. 2018;doi:10.1016/j.jacc.2018.08.1216.

Disclosure: Nfor reports no relevant financial disclosures.

SAN DIEGO — Patients with occlusive lower extremity peripheral artery disease treated with atherectomy devices had over 96% procedural success, according to data presented at TCT 2018.

When the researchers compared results by atherectomy device type, excisional atherectomy was associated with higher rates of vessel dissection and perforation and lower amputation rates compared with laser or orbital atherectomy, although long-term vessel patency was similar in all groups.

Tonga Nfor, MD, cardiologist at Aurora Cardiovascular Services at Aurora Sinai/Aurora St. Luke’s Medical Centers at University of Wisconsin School of Medicine and Public Health in Milwaukee, and colleagues analyzed data from 9,814 patients in the multicenter PVI Registry who underwent atherectomy for the treatment of occlusive disease of infrainguinal arteries. Patients were categorized by atherectomy type: laser (n = 1,577; mean age, 68 years; 42% women), orbital (n = 5,140; mean age, 69 years; 38% women) and excisional (n = 3,097; mean age, 69 years; 42% women).

“If we had a device and we had clear anatomic definition of where the device was used, how it was used and why it was used, all of those patients were included in this study,” Nfor said during the presentation.

Follow-up was conducted for a median of 380 days.

Although all atherectomy devices achieved 96% procedural success, it was highest in patients treated with excisional atherectomy vs. those treated with orbital or laser atherectomy (98.8% vs. 96.7% vs. 97.8%, respectively; P < .001).

“This has been a selling point of these [atherectomy] devices from the companies, that it makes the procedure easier, as you can tell from the very high procedural success rates, all in the very high 90s,” Nfor said during the presentation.

The excisional atherectomy group had higher rates of vessel perforation compared with orbital or laser atherectomy (1.5% vs. 0.7% vs. 0.6%, respectively; P < .001). Patients treated with laser atherectomy had higher rates of stent use compared with excisional and orbital atherectomy (34% vs. 26.4% vs. 20.6%, respectively; P < .001).

“The use of stents would depend on what vascular territory you are working in,” Nfor said. “If you worked in the femoropopliteal territory, the need for stenting is usually higher, with about 30% of those patients needing stenting in the femoropopliteal territory. With patients that laser atherectomy, they had higher rates of bailout stenting as compared to orbital and excisional atherectomy.”

Primary patency rates did not differ between atherectomy devices at 6 months (P = .47) or at 12 months (P = .81).

Rates of target limb amputation were lowest in patients treated with excisional atherectomy compared with orbital or laser atherectomy (2.3% vs. 3.1% vs. 3.7%, respectively; P = .01).

“Choice of device should mainly be driven by operator experience and local availability,” Nfor said. – by Darlene Dobkowski

References:

Nfor T, et al. Abstract 114. Presented at: TCT Scientific Symposium; Sept. 21-25, 2018; San Diego.
Nfor T, et al. J Am Coll Cardiol. 2018;doi:10.1016/j.jacc.2018.08.1216.

Disclosure: Nfor reports no relevant financial disclosures.

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