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

Research output: Contribution to journalArticle

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)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Atherectomy
Registries
Knee
Extremities
Peripheral Arterial Disease
Ischemia
Ankle Brachial Index
Balloon Angioplasty
African Americans
Stents
Comorbidity
Chronic Disease

Keywords

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

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Atherectomy in below-the-knee endovascular interventions : One-year outcomes from the XLPAD registry. / Khalili, Houman; Jeon-Slaughter, Haekyung; Armstrong, Ehrin J.; Baskar, Amutharani; Tejani, Ishita; Shammas, Nicolas W.; Prasad, Anand; Abu-Fadel, Mazen; Brilakis, Emmanouil S; Banerjee, Subhash.

In: Catheterization and Cardiovascular Interventions, 01.01.2018.

Research output: Contribution to journalArticle

Khalili, Houman ; Jeon-Slaughter, Haekyung ; Armstrong, Ehrin J. ; Baskar, Amutharani ; Tejani, Ishita ; Shammas, Nicolas W. ; Prasad, Anand ; Abu-Fadel, Mazen ; Brilakis, Emmanouil S ; Banerjee, Subhash. / Atherectomy in below-the-knee endovascular interventions : One-year outcomes from the XLPAD registry. In: Catheterization and Cardiovascular Interventions. 2018.
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title = "Atherectomy in below-the-knee endovascular interventions: One-year outcomes from the XLPAD registry",
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.",
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T1 - Atherectomy in below-the-knee endovascular interventions

T2 - One-year outcomes from the XLPAD registry

AU - Khalili, Houman

AU - Jeon-Slaughter, Haekyung

AU - Armstrong, Ehrin J.

AU - Baskar, Amutharani

AU - Tejani, Ishita

AU - Shammas, Nicolas W.

AU - Prasad, Anand

AU - Abu-Fadel, Mazen

AU - Brilakis, Emmanouil S

AU - Banerjee, Subhash

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - ATHY – Atherectomy

KW - critical

KW - directional/rotational

KW - LIC - limb ischemia

KW - PAD - peripheral arterial disease

KW - PINT - peripheral intervention

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U2 - 10.1002/ccd.27897

DO - 10.1002/ccd.27897

M3 - Article

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JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

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