Atherectomy Adjuvant Balloon Angioplasty versus Balloon Angioplasty Alone in the Treatment of Peripheral Artery Disease

B. C. Cronquist, S. Gutti, M. Rahimi, D. Scher

Purpose: Peripheral arterial disease (PAD) is a pervasive condition with an incidence of more than 3,000,000 new diagnoses in the United States each year. Poorly controlled PAD may progress to critical limb ischemia (CLI), a severe stage associated with risk of limb loss or amputation. Two common options for endovascular intervention include percutaneous transluminal angioplasty (PTA), which involves balloon inflation to push plaque into the vessel wall and reestablish blood flow, and atherectomy (AT), which uses an additional device to disrupt plaque and remove it from the vessel wall. The purpose of this review study is to compare the technical success and primary patency rates of PTA plus AT versus PTA alone in the treatment of patients with PAD and CLI to determine which is the more effective treatment option.

Materials and Methods: A literature review was done to compare technical success rates (TSRs) and primary patency rates (PPRs) between PTA plus AT versus PTA alone. Among the three studies that met inclusion criteria, a total of 662 lesions were treated, of which 316 received PTA plus AT while 346 of the cases received PTA only. TSR was defined as less than 30% stenosis, and PPR was defined as no additional intervention needed to retain vessel patency within 12 months.

Results: For comparison of TSR, PTA plus AT performed significantly better than PTA alone (96.2% vs 87.6%; P<.00001). When comparing PPR, there was no significant difference between PTA plus AT versus PTA alone (89.2% vs 86.4%; P=2.67).

Conclusions: The results of this review indicate that PTA plus AT has a higher TSR than PTA alone, but there was no significant difference in PPR at 12 months postintervention. To fully determine the clinical significance of these results, further research should investigate long-term patency rates and complication rates.