Novel Endovascular Devices and Techniques in the Management of Peripheral Arterial Disease

V. Nguyen, V. Pham, Z. Billah, C. Lam

Purpose: Endovascular management of peripheral arterial disease (PAD) has undergone a renaissance since the first angioplasty performed by Charles Dotter in 1964. Significant advancement in medical device technology has resulted in new approaches and techniques to tackle complex lesions such as heavily calcified plaques and in-stent restenosis, which have been historically associated with lower technical success rates and higher complication rates. The purpose of this study is to review the safety and efficacy of some of these novel devices and techniques specifically engineered to treat patients with these complex lesions, including atherectomy devices, specialty balloon catheters, helical stent technology, and dissection repair devices.

Materials and Methods: The literature was reviewed using online research databases. The devices included in this study are the Serranator Alto PTA Serration Balloon catheter, Shockwave Intravascular Lithotripsy balloon catheter, Rotarex Excisional Atherectomy & Thrombectomy system, BioMimics 3D Vascular Stent system, and Tack Dissection Repair system. 

Results: All novel devices reviewed in this study were found to be safe and efficacious in the treatment of patients with PAD. The Serranator Alto balloon catheter was associated with high rates of technical and clinical success with low rates of dissection and bailout stenting. The Shockwave Intravascular Lithotripsy balloon catheter was associated with lower rates of provisional stenting and high rates of primary patency at 1 year. The Rotarex excisional atherectomy system was associated with high rates of target lesion revascularization, primary and secondary patency, and low rates of bailout stenting. The BioMimics stent was associated with high primary stent patency and low adverse events. The Tack dissection repair system was associated with up to 90% rate of dissection resolution above the knee and 100% rate of dissection resolution below the knee.

Conclusions: Novel endovascular devices and techniques including specialized balloon technology, atherectomy, and specialized dissection repair devices are safe and efficacious. These techniques are important additions to the toolbox of modern interventionalists treating patients with PAD.