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Published on: September 22, 2020
Procedural and clinical outcomes with catheter-based plaque excision in critical limb ischemia
David E Kandzari1, R Stefan Kiesz, David Allie
1Duke Clinical Research Institute, Durham, North Carolina 27705, USA. david.kandzari@duke.edu
Insights
Catheter-based plaque excision offers a safe and effective treatment for critical limb ischemia (CLI). This endovascular therapy successfully salvaged limbs, avoiding or reducing amputations in most patients.
Area of Science:
- Vascular Surgery
- Endovascular Therapy
- Peripheral Artery Disease
Background:
- Critical limb ischemia (CLI) poses a significant risk for limb loss.
- Traditional treatments include surgery and angioplasty/stenting.
- High-risk patients often require alternative revascularization strategies.
Purpose of the Study:
- To evaluate catheter-based plaque excision for CLI.
- To compare its safety and efficacy against surgery, angioplasty, and stenting.
- To assess its role as an alternative therapy in high-risk CLI patients.
Main Methods:
- Prospective evaluation of 69 CLI patients (76 limbs) across 7 institutions.
- Treatment involved endovascular plaque excision.
- Outcomes followed for 6 months, focusing on major adverse events and limb salvage.
Main Results:
- 99% procedural success rate.
- Low 30-day major adverse event rate (1%).
- High rates of amputation avoidance (92% at 30 days, 82% at 6 months) or less extensive amputation.
Conclusions:
- Catheter-based plaque excision is a safe and effective revascularization method for CLI.
- Demonstrates significant limb salvage potential.
- Supports further investigation as a primary or adjunctive endovascular therapy.
Purpose:
To examine the safety and efficacy of catheter-based plaque excision as an alternative therapy to surgery, conventional angioplasty, and/or stenting in high-risk patients with critical limb ischemia (CLI).
Methods:
Between August 2003 and August 2004, a prospective evaluation was conducted of consecutive patients with CLI (Rutherford category>or=5) who were treated with endovascular plaque excision at 7 institutions. This study enrolled 69 patients (37 women; mean age 70+/-12 years, range 43-93) with CLI involving 76 limbs. Clinical outcomes were prospectively followed for 6 months. The primary endpoint was major adverse events (death, myocardial infarction, unplanned amputation, or repeat target vessel revascularization) at 30 days. Visible healing of ulcerated tissue, avoidance of any amputation, and performance of less extensive amputation than initially planned were also assessed.
Results:
Procedural success was achieved in 99% of cases. Major adverse events occurred in 1% of patients at 30 days and 23% at 6 months. The target lesion revascularization rate was 4%, and there were no unplanned limb amputations. Amputation was less extensive than initially planned or avoided altogether in 92% of patients at 30 days and 82% at 6 months.
Conclusion:
Catheter-based plaque excision is a safe and effective revascularization method for patients with CLI. These findings support further study of this modality as a singular or adjunctive endovascular therapy for limb salvage in CLI.
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