Plaque excision in the treatment of peripheral arterial disease

The goals of any percutaneous intervention in the lower extremity are to provide initial technical success and restore durable arterial patency. The first goal can be achieved through a multitude of endovascular techniques, whereas achieving the latter has remained elusive. The large number of choices in treatment options for percutaneous lower-extremity revascularization speak to the fact that no single tool or technique has been proven to be superior. The SilverHawk plaque excision system is designed to debulk stenotic or occlusive arterial lesions. Like many endovascular technologies, reports have focused on rates of initial technical success and short-term outcomes, but long-term results remain unknown. This report reviews selected published or presented results of plaque excision, touches on areas of concern or controversy regarding both the device and some of its proponents, and suggests clinical or anatomic settings in which plaque excision appears most effective. The ultimate utility of this technology will depend on confirmation of its acute and long-term outcomes through unbiased, well-designed clinical trials.