The major criticism of peripheral atherectomy continues to be "show me the data". The device companies counter with "we gave you what was necessary for approval... anything else is too expensive". EV3 has threatened that further studies are forthcoming. Until then, EVToday has a nice review article from Husami, Akhter and Lawrence Garcia at St Elizabeths in Boston.
Atherectomy in the Superficial Femoral Artery
An evidence-based approach for device selection, ideal applications, and cases to avoid.
By Wael F. Al-Husami, MD, FACC; Mohammed W. Akhter, MD; and Lawrence A. Garcia, MD, FACC, FAHA
Currently, there are multiple treatment strategies to address stenotic or occlusive atherosclerotic disease in the superficial femoral artery (SFA). Percutaneous transluminal angioplasty (PTA) results have traditionally been suboptimal and less durable, especially with longer-lesion subsets.1,2 Self-expanding nitinol stents do not perform as well when considering long-term patency rates (after 2 years) based on recently published stent trials, even though they are accepted as the default therapy for treating the SFA.3-5
Atherectomy in the peripheral vasculature has gained interest due to its perceived benefits over simple PTA. The theoretical avoidance of barotrauma and overstretch of the vessel wall is desirable and can prevent acute vessel recoil or dissection. These unwanted side effects can lead to restenosis or reocclusion in the treated vessel. However, it is unclear how often stand-alone therapy is done and what impact a "soft" balloon inflation after atherectomy may have with regard to patency rates.
The difference between journalism and literature is that journalism is unreadable and literature is not read. ~Oscar Wilde, The Picture of Dorian Gray, 1891
Posted by: art painting | July 25, 2010 at 11:45 PM