Atherectomy for peripheral arterial disease.
Bethany G Wardle1, Graeme K Ambler1,2, Rami W Radwan3
1Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Bristol, UK.
The Cochrane Database of Systematic Reviews
|September 29, 2020
Summary
Atherectomy for peripheral arterial disease (PAD) shows uncertain effectiveness compared to balloon angioplasty (BA), with no clear differences in patency or mortality. Evidence suggests potential reductions in dissection and bailout stenting, but more research is needed.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Evidence-Based Medicine
Background:
- Symptomatic peripheral arterial disease (PAD) significantly impacts patient quality of life.
- Established treatments for PAD include angioplasty, stenting, exercise therapy, and bypass surgery.
- Atherectomy offers an alternative by removing atheroma from within arteries.
Purpose of the Study:
- To evaluate the effectiveness of atherectomy for symptomatic peripheral arterial disease (PAD).
- To compare atherectomy outcomes against other established PAD treatments, including balloon angioplasty (BA) and stenting.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched multiple databases up to August 2019 for relevant studies.
- Included RCTs comparing atherectomy with other treatments in symptomatic PAD patients.
Main Results:
- Seven studies with 527 participants were included; evidence quality was very low.
- No clear differences found between atherectomy and BA (with or without stenting) for primary patency, mortality, or target vessel revascularization (TVR).
- Atherectomy may reduce dissection and bailout stenting, but findings are uncertain due to high risk of bias and imprecision.
Conclusions:
- Current evidence on atherectomy for PAD is of very low certainty.
- No definitive conclusions can be drawn regarding its superiority over balloon angioplasty.
- Larger, high-quality RCTs are necessary to determine the true efficacy and safety of atherectomy for PAD.
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