Outcomes of Patients Treated with the Everolimus- versus the Paclitaxel-Eluting Stents in a Consecutive Cohort of Patients at a Tertiary Medical Center

Phoenix atherectomy for patients with peripheral artery disease

BACKGROUND

Endovascular atherectomy enables minimally invasive plaque removal in peripheral artery disease (PAD).

AIMS

We aimed to evaluate the safety and the long-term effectiveness of the Phoenix atherectomy for the treatment of complex and calcified lesions in PAD patients.

METHODS

Consecutive all-comer patients with PAD underwent the Phoenix atherectomy. Device safety in terms of perforation and distal embolisation were evaluated. Lesion calcifications were categorised by the Peripheral Arterial Calcium Scoring System (PACSS) and lesion complexity was assessed by the Transatlantic Inter-Society Consensus (TASC). Clinically driven target lesion revascularisation (TLR) was assessed.

RESULTS

A total of 558 lesions were treated in 402 consecutive patients. Clinical follow-up was available at 15.7±10.2 months for 365 (91%) patients. Of 402 patients, 135 (33.6%) had claudication, 37 (9.2%) had ischaemic rest pain and 230 (57%) exhibited ischaemic ulcerations. Lesions were mostly identified in the femoropopliteal segments (55%), followed by below-the-knee (BTK) segments (32%). Complex TASC C/D lesions and moderate to severe calcifications (PACSS score ≥2) were present in 331 (82%) and 323 (80%) patients, respectively. The mean lesion length was 20.6±14.3 cm. Five (1%) perforations and 10 (2%) asymptomatic embolisations occurred. Bail-out stenting was performed in 4%, 16% and 3% of patients with common femoral artery, femoropopliteal and BTK lesions, respectively. During follow-up, 5 (3.9%) patients with claudication and 52 (21.9%) patients with critical limb-threatening ischaemia (CLTI) died (hazard ratio [HR] 3.7; p<0.001). Freedom from TLR was 87.5% (112 of 128) in patients with claudication and 82.3% (195 of 237) in patients with CLTI, respectively (HR 1.8; p=0.03).

CONCLUSIONS

The Phoenix atherectomy can be safely performed in patients with complex lesions with a relatively low rate of bail-out stenting and clinically acceptable TLR rates.

GERMAN CLINICAL TRIALS REGISTER

DRKS00016708.

Performance Assessment of a Radiofrequency Powered Guidewire for Crossing Peripheral Arterial Occlusions Based on Lesion Morphology

Endovascular wires and devices for peripheral arterial disease therapy have evolved greatly, yet failure rates of these procedures remain high. Information on lesion composition may inform device selection to improve the success rates of these procedures. This paper, presents an approach for informed guidewire selection. The objective of this study is to quantitatively assess the performance of a radiofrequency powered guidewire in the crossing of various morphology types of peripheral chronic total occlusions. Samples taken from amputated patient limbs are characterized by magnetic resonance imaging. Using a customized catheter test station, the performance of a radiofrequency powered guidewire in puncturing these lesions is compared to a conventional guidewire, and to itself when not powered. The analysis includes quantitative and statistical comparisons of the puncture forces experienced by the different guidewires in "hard" vs. "soft" lesions as well as qualitative assessment of deflections, buckling and puncture success of the wires. Results indicate that the use of radiofrequency ablation significantly reduces the required puncture force, reduced events of buckling and deflection, and resulted in a significantly higher puncture success rate.

Treatment of Femoropopliteal Artery In-stent Restenosis

Femoropopliteal (FP) artery-in stent restenosis (ISR) is a daunting management problem that we continue to face. FP artery-ISR rates after primary stent implantation are relatively high. Although repeat FP artery-ISR and the need for additional interventions remain all too common, little consensus exists regarding the best treatment algorithm. In this article, we review the limitations of the currently used devices for the endovascular treatment of FP artery-ISR and discuss which strategies are the most effective and safe.