Atherectomy in below-the-knee endovascular interventions: One-year outcomes from the XLPAD registry

Houman Khalili, Haekyung Jeon-Slaughter, Ehrin J. Armstrong, Amutharani Baskar, Ishita Tejani, Nicolas W. Shammas, Anand Prasad, Mazen Abu-Fadel, Emmanouil S. Brilakis, Subhash Banerjee

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Abstract

Background: Use of atherectomy for the treatment of peripheral arterial disease (PAD) is increasing as an adjunctive treatment to either conventional or drug-coated balloon angioplasty. There is limited data on atherectomy outcomes in below-the-knee (BTK) endovascular interventions. Methods: Data from the multicenter Excellence in Peripheral Artery Disease (XLPAD) registry (NCT01904851) were analyzed to examine predictors of atherectomy use and its associated 1-year patency rate. We analyzed 518 BTK procedures performed between January 2005 and December 2016. Results: Overall a total of 518 BTK procedures were treated in 430 patients, and 43% of interventions used atherectomy. African American patients were less likely (13% vs 25%; |standard residual| = 3.41) to be treated with atherectomy. Use of atherectomy was lower in chronic total occlusive (CTO) lesions (48% vs 58%; P = 0.02). There were no significant associations of baseline comorbidities, critical limb ischemia (CLI), ankle-brachial index, number of BTK vessel run-off, or vessel location with atherectomy use. Compared with patients without atherectomy, use of atherectomy was associated with lower incidence of repeat target limb intervention at 1 year after adjusting for age, CLI, in-stent restenosis, heavy calcification, presence of diffuse disease, and CTO lesion traits (Hazard Ratio 0.41, 95% confidence interval 0.23-0.72; P < 0.01). Conclusions: Compared with no atherectomy, use of atherectomy in BTK interventions is associated with lower rates of 1-year repeat target limb revascularization. These findings require confirmation in prospective, randomized clinical studies.

Original languageEnglish (US)
Pages (from-to)488-493
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Volume93
Issue number3
DOIs
StatePublished - Feb 15 2019

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Keywords

  • ATHY – Atherectomy
  • LIC - limb ischemia
  • PAD - peripheral arterial disease
  • PINT - peripheral intervention
  • critical
  • directional/rotational

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Khalili, H., Jeon-Slaughter, H., Armstrong, E. J., Baskar, A., Tejani, I., Shammas, N. W., Prasad, A., Abu-Fadel, M., Brilakis, E. S., & Banerjee, S. (2019). Atherectomy in below-the-knee endovascular interventions: One-year outcomes from the XLPAD registry. Catheterization and Cardiovascular Interventions, 93(3), 488-493. https://doi.org/10.1002/ccd.27897