A Comparison between Outcomes of Atherectomy Devices Used in Patients with Infrainguinal Peripheral Vascular Disease

Background:

Atherectomy-assisted (ATHERO) infrainguinal peripheral vascular interventions have gained

popularity over the past decade. In this analysis we evaluate the safety and efficacy of each

ATHERO device used in patients with symptomatic infrainguinal peripheral vascular disease.

Methods:

MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were queried from

January 1991 through December 2015. Two independent reviewers selected studies and

extracted data in duplicate. Random-effects meta-analysis was used to pool outcomes across

studies. Study endpoints included short-term procedural outcomes (defined as technical

success with residual stenosis<30%, and lack of dissection, perforation or distal embolization)

and 12 month patency rate.

Results:

A total of 4260 patients were included from 30 studies. Mean age was 69 and 54% were male.

No evidence of publication bias was detected. Technical success with residual stenosis < 30%

was the highest in patients who underwent Orbital ATHERO interventions (90% with 95% CI of

82.6 to 97.3) and the lowest in Rotational ATHERO interventions (79.7% with 95% CI, of 59.1 to

100.3). Dissection was the highest with Orbital ATHERO at 9.5% (95% CI, -2.5 to 21.5) and

least likely to happen with Rotational ATHERO at 1.4% (95% CI, 0.0 to 2.7). Highest perforation

rates were observed with Directional ATHERO at 2.3% (95% CI 1.0 to 3.7), and lowest with

Orbital ATHERO at 0.3% (95% CI, -0.4 to 1). One-year patency rate was highest with Directional

ATHERO and lowest with Pathway system interventions 64.8% (CI 95%, 47.3 to 82.4) vs. 42.9%

(29.0 to 56.7) respectively.

Conclusions:

In this analysis, we report varying procedural and 12-month outcomes associated with

commercially available ATHERO devices. Future randomized studies are crucial to delineate

outcomes associated with these devices.