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KEY FACTS
Terminology
Procedure
Outcomes
TERMINOLOGY
Definitions
- Atherectomy: Physical removal of atherosclerotic plaque, typically by cutting, shaving, or abrading with catheter-based mechanical device
- Directional atherectomy
- Advantage of avoiding barotrauma
- Reduces risk of dissection & intimal hyperplasia
- Plaque excised by rotating cutting blade
- Blade housed in cutting window on device
- Bend in catheter apposes window against plaque
- Window rotated/positioned against plaque
- Blade excises only area that window exposes
- Excised plaque collected in chamber at device tip
- Device must be removed to empty chamber
- HawkOne/TurboHawk/Silverhawk (Medtronic)
- 0.014" monorail guidewire compatible
- Plaque excised is collected in tip; variable capacity
- HawkOne: 2- to 7-mm diameter vessel
- TurboHawk: Variant for highly calcified lesions
- Advantage of avoiding barotrauma
- Rotational atherectomy
- High-speed 360° rotating device tip or burr
- Preferentially abrades inelastic plaque
- Microscopic nonobstructing particles enter arterial circulation
- Phoenix (Volcano; San Diego, CA): 5-Fr, over-the-wire rotating blades pull debris into catheter, reducing risk of distal emboli
- Jetstream (Boston Scientific): Rotating cutting tip expands; continuous infusion & aspiration removes excised debris without device removal; use in mixed calcified/thrombotic lesions
- ROTAPRO (Boston Scientific): Rotating diamond-coated burr
- Orbital atherectomy
- Diamondback 360° (Cardiovascular Systems): Rotating diamond-coated crown, 4-Fr device, used in arteries as small as 2 mm in diameter
- Eccentrically mounted rotating crown sands plaque
- Diamondback 360° (Cardiovascular Systems): Rotating diamond-coated crown, 4-Fr device, used in arteries as small as 2 mm in diameter
- Laser atheroablation
- CVX-300 Laser System (Philips)
- Turbo-Elite laser atherectomy catheter
- CVX-300 Laser System (Philips)
- Directional atherectomy
- Atherectomy: Physical removal of atherosclerotic plaque, typically by cutting, shaving, or abrading with catheter-based mechanical device
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Equipment Preparation
Procedure Steps
Alternative Procedures/Therapies
OUTCOMES
Complications
Expected Outcomes
Selected References
- Wardle BG et al: Atherectomy for peripheral arterial disease. Cochrane Database Syst Rev. 9:CD006680, 2020
- Dippel EJ et al: Randomized controlled study of excimer laser atherectomy for treatment of femoropopliteal in-stent restenosis: initial results from the EXCITE ISR trial (EXCImer Laser Randomized Controlled Study for Treatment of FemoropopliTEal In-Stent Restenosis). JACC Cardiovasc Interv. 8(1 Pt A):92-101, 2015
- Diamantopoulos A et al: Atherectomy of the femoropopliteal artery: a systematic review and meta-analysis of randomized controlled trials. J Cardiovasc Surg (Torino). 55(5):655-65, 2014
- Feldman DN: Atherectomy for calcified femoropopliteal disease: are we making progress? J Invasive Cardiol. 26(8):304-6, 2014
- Kim JH et al: Identifying the target lesions for 245 laser angioplasty cases and a review of the literature. Vasc Endovascular Surg. 46(8):640-7, 2012
- Mezilis N et al: Rotablation in the drug eluting era: immediate and long-term results from a single center experience. J Interv Cardiol. 23(3):249-53, 2010
- Garcia LA et al: Atherectomy for infrainguinal peripheral artery disease. J Endovasc Ther. 16:II105-15, 2009
- Kaid KA et al: Analysis of particulate debris after superficial femoral atherectomy. J Invasive Cardiol. 21(1):7-10, 2009
- Shavelle DM: Plaque excision with distal protection: a logical next step for superficial femoral artery SilverHawk atherectomy. J Invasive Cardiol. 21(1):11-2, 2009
- Zeller T et al: One-year outcome of percutaneous rotational atherectomy with aspiration in infrainguinal peripheral arterial occlusive disease: the multicenter pathway PVD trial. J Endovasc Ther. 16(6):653-62, 2009
- Biskup NI et al: Infrainguinal atherectomy: a retrospective review of a single-center experience. Ann Vasc Surg. 22(6):776-82, 2008
- McKinsey JF et al: Novel treatment of patients with lower extremity ischemia: use of percutaneous atherectomy in 579 lesions. Ann Surg. 248(4):519-28, 2008
- Ramaiah V: Endovascular infrainguinal revascularization: technical tips for atherectomy device selection and procedural success. Semin Vasc Surg. 21(1):41-9, 2008
- Sarac TP et al: Midterm outcome predictors for lower extremity atherectomy procedures. J Vasc Surg. 48(4):885-90; discussion 890, 2008
- Shammas NW et al: Preventing lower extremity distal embolization using embolic filter protection: results of the PROTECT registry. J Endovasc Ther. 15(3):270-6, 2008
- Bunting TA et al: Peripheral atherectomy: a critical review. J Interv Cardiol. 20(6):417-24, 2007
- Zeller T et al: Two-year results after directional atherectomy of infrapopliteal arteries with the SilverHawk device. J Endovasc Ther. 14(2):232-40, 2007
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References
Tables
Tables
KEY FACTS
Terminology
Procedure
Outcomes
TERMINOLOGY
Definitions
- Atherectomy: Physical removal of atherosclerotic plaque, typically by cutting, shaving, or abrading with catheter-based mechanical device
- Directional atherectomy
- Advantage of avoiding barotrauma
- Reduces risk of dissection & intimal hyperplasia
- Plaque excised by rotating cutting blade
- Blade housed in cutting window on device
- Bend in catheter apposes window against plaque
- Window rotated/positioned against plaque
- Blade excises only area that window exposes
- Excised plaque collected in chamber at device tip
- Device must be removed to empty chamber
- HawkOne/TurboHawk/Silverhawk (Medtronic)
- 0.014" monorail guidewire compatible
- Plaque excised is collected in tip; variable capacity
- HawkOne: 2- to 7-mm diameter vessel
- TurboHawk: Variant for highly calcified lesions
- Advantage of avoiding barotrauma
- Rotational atherectomy
- High-speed 360° rotating device tip or burr
- Preferentially abrades inelastic plaque
- Microscopic nonobstructing particles enter arterial circulation
- Phoenix (Volcano; San Diego, CA): 5-Fr, over-the-wire rotating blades pull debris into catheter, reducing risk of distal emboli
- Jetstream (Boston Scientific): Rotating cutting tip expands; continuous infusion & aspiration removes excised debris without device removal; use in mixed calcified/thrombotic lesions
- ROTAPRO (Boston Scientific): Rotating diamond-coated burr
- Orbital atherectomy
- Diamondback 360° (Cardiovascular Systems): Rotating diamond-coated crown, 4-Fr device, used in arteries as small as 2 mm in diameter
- Eccentrically mounted rotating crown sands plaque
- Diamondback 360° (Cardiovascular Systems): Rotating diamond-coated crown, 4-Fr device, used in arteries as small as 2 mm in diameter
- Laser atheroablation
- CVX-300 Laser System (Philips)
- Turbo-Elite laser atherectomy catheter
- CVX-300 Laser System (Philips)
- Directional atherectomy
- Atherectomy: Physical removal of atherosclerotic plaque, typically by cutting, shaving, or abrading with catheter-based mechanical device
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Equipment Preparation
Procedure Steps
Alternative Procedures/Therapies
OUTCOMES
Complications
Expected Outcomes
Selected References
- Wardle BG et al: Atherectomy for peripheral arterial disease. Cochrane Database Syst Rev. 9:CD006680, 2020
- Dippel EJ et al: Randomized controlled study of excimer laser atherectomy for treatment of femoropopliteal in-stent restenosis: initial results from the EXCITE ISR trial (EXCImer Laser Randomized Controlled Study for Treatment of FemoropopliTEal In-Stent Restenosis). JACC Cardiovasc Interv. 8(1 Pt A):92-101, 2015
- Diamantopoulos A et al: Atherectomy of the femoropopliteal artery: a systematic review and meta-analysis of randomized controlled trials. J Cardiovasc Surg (Torino). 55(5):655-65, 2014
- Feldman DN: Atherectomy for calcified femoropopliteal disease: are we making progress? J Invasive Cardiol. 26(8):304-6, 2014
- Kim JH et al: Identifying the target lesions for 245 laser angioplasty cases and a review of the literature. Vasc Endovascular Surg. 46(8):640-7, 2012
- Mezilis N et al: Rotablation in the drug eluting era: immediate and long-term results from a single center experience. J Interv Cardiol. 23(3):249-53, 2010
- Garcia LA et al: Atherectomy for infrainguinal peripheral artery disease. J Endovasc Ther. 16:II105-15, 2009
- Kaid KA et al: Analysis of particulate debris after superficial femoral atherectomy. J Invasive Cardiol. 21(1):7-10, 2009
- Shavelle DM: Plaque excision with distal protection: a logical next step for superficial femoral artery SilverHawk atherectomy. J Invasive Cardiol. 21(1):11-2, 2009
- Zeller T et al: One-year outcome of percutaneous rotational atherectomy with aspiration in infrainguinal peripheral arterial occlusive disease: the multicenter pathway PVD trial. J Endovasc Ther. 16(6):653-62, 2009
- Biskup NI et al: Infrainguinal atherectomy: a retrospective review of a single-center experience. Ann Vasc Surg. 22(6):776-82, 2008
- McKinsey JF et al: Novel treatment of patients with lower extremity ischemia: use of percutaneous atherectomy in 579 lesions. Ann Surg. 248(4):519-28, 2008
- Ramaiah V: Endovascular infrainguinal revascularization: technical tips for atherectomy device selection and procedural success. Semin Vasc Surg. 21(1):41-9, 2008
- Sarac TP et al: Midterm outcome predictors for lower extremity atherectomy procedures. J Vasc Surg. 48(4):885-90; discussion 890, 2008
- Shammas NW et al: Preventing lower extremity distal embolization using embolic filter protection: results of the PROTECT registry. J Endovasc Ther. 15(3):270-6, 2008
- Bunting TA et al: Peripheral atherectomy: a critical review. J Interv Cardiol. 20(6):417-24, 2007
- Zeller T et al: Two-year results after directional atherectomy of infrapopliteal arteries with the SilverHawk device. J Endovasc Ther. 14(2):232-40, 2007
