Atherectomy Treatment Strategies of Above Knee-Only or Combined Above Knee and Below Knee Both Result in Successful Reduction of Stenosis as Measured by DUS PSVR
Alireza Daneshpajouh, DO, Margo Carlin, DO, Zachary Belnavis, BS, Brad Martinsen, PHD, Joseph J. Ricotta II, MD, MS, FACS.
Delray Medical Center, Delray Beach, FL, USA.
OBJECTIVES: Advanced peripheral artery disease (PAD) patients tend to have multilevel disease often requiring atherectomy. Above-the-Knee only (ATK-only) atherectomy treatment is often insufficient in these patients, whereas a ATK-and-Below-the-Knee (ATK-and-BTK) atherectomy treatment is currently debated and is viewed as more complex and prone to result in worse outcomes. We hypothesized that atherectomy treatment strategies of ATK-only or ATK-and-BTK can both be successful, resulting in similar reduction in stenosis as measured via peak systolic velocity ratio (PSRV) rates. sR Thus, we sought to compare the reduction of stenosis via atherectomy treatment in ATK-only versus ATK-and-BTK (BTK-only subgroup included).
METHODS: The clinical data of all patients treated with atherectomy (orbital, laser, and directional) at our institution from 1/18/17 to 05/24/18 were prospectively collected. Baseline, procedural, and follow-up DUS PSVR data were compared in ATK-only atherectomy versus combined ATK-and-BTK atherectomy (a BTK-only atherectomy subgroup was also included). An orbital atherectomy(OA) subanalysis on all vessels treated was also completed.
RESULTS: 110 patients were treated with atherectomy, 59 were ATK-only, 37 were ATK-and-BTK, and 14 were BTK-only. The Max PSVR at baseline and 30-day follow-up are shown in Figure 1A. ( At baseline, the mean Max PSVR ATK-only, ATK-and-BTK, and BTK-only, were 3.0±1.9, 3.3±1.6, 2.8±1.2, respectively; and at 30-day follow-up they were 2.6±1.1, 2.7±2.3, and 2.3±1.2, respectively. The ATK-and-BTK cohort showed numerically higher mean Max PSVR at baseline compared to ATK-only and the BTK-only cohorts. At 30-day follow-up all three cohorts resulted in mean Max PSVRs below 2.7, indicating patency (<50% stenosis level) was maintained. B, An OA subanalysis (n=44) (Figure1B) on all vessels treated (ATK and/or BTK), indicated baseline and 30-day follow-up mean Max PSVRs of 3.0±1.6 and 2.5±1.9, respectively—indicating a statistically significant reduction in PSVR and stenosis severity level after OA treatment.
CONCLUSIONS: Our study demonstrates despite the greater median Max PSVR at baseline in the ATK-and-BTKy group, all groups resulted in similar favorable PSVR patency at follow-up. These results suggest that an ATK-and-BTK atherectomy strategy in advanced PAD patients can be as successful as a ATK-only atherectomy strategy. In addition, OA treatment (ATK and/or BTK) resulted in a significant reduction in PSVR/stenosis. 
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