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SIR 2025

Peripheral Arterial Disease (PAD)

Scientific Session

Session: Arterial - Peripheral

Assessing Outcomes of Femoropopliteal Lesions with Atherectomy Devices of Different Mechanisms of Action

Sunday, March 30, 2025
3:00 PM – 3:09 PM CT
Location: Music City Center, 205 BC
Purpose: Treatment of peripheral arterial disease of the lower limbs continues to pose a challenge to the healthcare system financially and medically. To meet this need, novel atherectomy devices with varying mechanisms of action have been invented over the years, including the directional (DA), rotational (RA), and laser atherectomy (LA). Despite their popularity, their efficacy has been a controversial topic. In addition, little to no studies have compared three or more device types.

Materials and Methods: TriNetX was used to evaluate patient electronic medical records between January 1st, 2016 and September 1st, 2023. Patients were identified who had undergone femoropopliteal angioplasty + atherectomy. Patients receiving a first-time peripheral vascular intervention were included in our study. Patients were divided into three groups depending on the atherectomy device used: laser (n = 749), rotational (n = 1781), or directional (n = 2324). A control group consisted of patients that underwent only angioplasty (n = 18511). Patients were matched for hypertension, heart disease, hyperlipidemia, diabetes, smoking, history of MI, and history of CVA. The primary outcome measured was bailout stenting (BOS), defined as the rate of post-procedural stent placement. Secondary outcomes included amputations (below-the-knee (BKA) vs above-the-knee (AKA) vs distal lower extremity amputations (DLEA)) and revascularizations within 1 year post-procedurally.

Results: LA was associated with higher rates of BOS compared to RA and DA (49.53% vs 26.50% vs 22.80%, p < .00001), with no significant difference in BOS between LA and angioplasty. LA was also associated with a greater risk of revascularization compared to RA (RR = 1.39, 95% CI (1.10,1.75)) and DA (RR = 1.38, 95% CI (1.09,1.73)) and at a greater risk of BKA compared to RA (RR = 1.98, 95% CI (1.02,4.17)). DA had a greater risk of DLEA compared to RA (RR = 1.67, 95% CI (1.24,2.25)). RA was found to have a lower risk of AKA (RR = .41, 95% CI (0.24,0.69)) and DLEA (RR = .68, (95% CI (0.50,0.94)) compared to angioplasty alone while DA use was found to have a lower risk of AKA (RR = .56, 95% CI (0.38,0.84)) compared to angioplasty only. LA had a greater risk of revascularization (RR = 1.85, 95% CI (1.44,2.39)) compared to angioplasty only.

Conclusion: Laser atherectomy is associated with a greater risk of complications, revascularizations, and bailout stenting when compared to directional and rotational devices. All three were associated with a greater risk of revascularizations when compared to angioplasty alone. Further studies are needed to ascertain atherectomy’s efficacy.