The Logic Behind Leaving Nothing Behind

During the “Vessel Preparation for CLI” session on Thursday morning. Sonya Noor, MD, from the Gates Vascular Institute in Buffalo, New York, gave a presentation that focused on the strategic use of atherectomy in vascular interventions, emphasizing the principle of "leaving nothing behind." This approach is particularly beneficial for preserving future treatment options, especially in younger patients and in critical anatomical areas where stenting might compromise future revascularization efforts.

Dr. Noor provided several key points, including:

• Clinical challenges: Atherectomy is highly effective in managing complex vascular lesions, including those with significant calcium deposits, chronic total occlusions (CTOs), and in-stent restenosis. It’s especially useful in treating lesions in no-stent zones such as the common femoral artery (CFA) and popliteal artery, where maintaining future bypass options is crucial.
• Procedural goals: The goals of atherectomy include optimizing luminal gain while minimizing vessel injury, avoiding long lesion stenting, and preparing vessels for additional treatments, such as drug-coated balloons (DCBs) or drug-eluting stents (DES).
• Atherectomy applications: The technique is particularly advantageous in non-stent zones, small vessels, and severely calcified lesions. By using differential cutting technology, atherectomy devices can selectively remove plaque without damaging the vessel wall, making them ideal for bifurcation lesions.

• Impact of calcification on DCB efficacy: Dr. Noor discussed how heavy calcification can reduce the effectiveness of DCBs, leading to lower patency rates and higher rates of target lesion revascularization (TLR).

The presentation included case studies demonstrating the successful use of atherectomy in tibial and inframalleolar vessels, resulting in significant clinical improvements, such as wound healing and increased ankle-brachial index (ABI).

In conclusion, Dr. Noor told attendees that atherectomy, aligned with the "leave nothing behind" philosophy, is a valuable tool for managing complex vascular lesions, offering immediate procedural benefits while preserving options for future interventions.