Laser Atherectomy for Infrapopliteal Lesions in Patients With Critical Limb Ischemia

被引:10
作者
Kokkinidis, Damianos G.
Giannopoulos, Stefanos
Jawaid, Omar
Cantu, David
Singh, Gagan D.
Armstrong, Ehrin J.
机构
[1] Univ Colorado, Div Cardiol, Rocky Mt Reg VA Med Ctr, Denver, CO 80202 USA
[2] Univ Calif Davis, Vasc Ctr, Sacramento, CA 95817 USA
[3] Univ Calif Davis, Div Cardiovasc Med, Sacramento, CA 95817 USA
关键词
Peripheral artery disease; Infrapopliteal disease; Below the knee arteries; Chronic total occlusions; Critical limb ischemia; Laser atherectomy; ASSISTED BALLOON ANGIOPLASTY; IN-STENT RESTENOSIS; PERIPHERAL ARTERIAL-DISEASE; EXCIMER-LASER; TASK-FORCE; POPLITEAL; OUTCOMES; INTERVENTIONS; MANAGEMENT; TRIAL;
D O I
10.1016/j.carrev.2020.08.041
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Infrapopliteal (IP) lesions are common in patients with critical limb ischemia (CLI). Optimal revascularization strategies including the use of adjunctive atherectomy have the potential to improve the outcomes for these patients. Objective: To compare laser atherectomy (LA) vs. balloon angioplasty alone for the treatment of IP lesions in patients with CLI. Methods: This was a two-center retrospective study of patients with CLI who underwent endovascular interventions for IP lesions. One and 2-year target lesion revascularization (TLR) was the primary outcome. One and 2-year limb loss and major adverse limb events (MALE) were secondary outcomes. Propensity score matching was performed. A Cox regression analysis was used to compare 1- and 2-year outcomes of the two groups. Logistic regression analysiswas used to compare the two groups in terms of bail-out stenting and procedural complications. Results: A total of 313 patients with CLI were included; 76 were treated with LA. There was a high degree of lesion complexity in both groups. Consistent with the application of LA in the most complex lesions, lesions in the LA group were significantly longer (165.7 mm vs. 94.1 mm; p < 0.001) and were more frequently TASC C/D (82% vs. 45%; p < 0.001). In-stent restenosis (ISR) lesions were also more common among the LA group (14% vs. 0.4%; p < 0.001). Thrombotic lesions were present in 11% of the LA group vs. 4% in the no LA group (p = 0.04). CTOs were also more common in the LA group (58% vs. 43%; p = 0.024). After propensity matching, therewas no difference in the 1 or 2-year TLR rates between the two groups. Similarly, therewere no differences between the two groups in terms of 1 or 2-year limb loss or 2-year major adverse limb events. Conclusions: LA is safe and effective for IP lesions in patients with CLI. There was a higher baseline angiographic complexity in patients treated with LA, suggesting that operators tend to use LA for the treatment ofmore complicated lesions. There was no difference among the two groups in 1- or 2-year outcomes of TLR of major amputation. (C) 2020 Published by Elsevier Inc.
引用
收藏
页码:79 / 83
页数:5
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