Cargando…

Technique Optimization of Orbital Atherectomy in Calcified Peripheral Lesions of the Lower Extremities: The CONFIRM Series, A Prospective Multicenter Registry

OBJECTIVES: The purpose of CONFIRM registry series was to evaluate the use of orbital atherectomy (OA) in peripheral lesions of the lower extremities, as well as optimize the technique of OA. BACKGROUND: Methods of treating calcified arteries (historically a strong predictor of treatment failure) ha...

Descripción completa

Detalles Bibliográficos
Autores principales: Das, Tony, Mustapha, Jihad, Indes, Jeffrey, Vorhies, Robert, Beasley, Robert, Doshi, Nilesh, Adams, George L
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Blackwell Publishing Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4158859/
https://www.ncbi.nlm.nih.gov/pubmed/23737432
http://dx.doi.org/10.1002/ccd.25046
_version_ 1782334126766948352
author Das, Tony
Mustapha, Jihad
Indes, Jeffrey
Vorhies, Robert
Beasley, Robert
Doshi, Nilesh
Adams, George L
author_facet Das, Tony
Mustapha, Jihad
Indes, Jeffrey
Vorhies, Robert
Beasley, Robert
Doshi, Nilesh
Adams, George L
author_sort Das, Tony
collection PubMed
description OBJECTIVES: The purpose of CONFIRM registry series was to evaluate the use of orbital atherectomy (OA) in peripheral lesions of the lower extremities, as well as optimize the technique of OA. BACKGROUND: Methods of treating calcified arteries (historically a strong predictor of treatment failure) have improved significantly over the past decade and now include minimally invasive endovascular treatments, such as OA with unique versatility in modifying calcific lesions above and below-the-knee. METHODS: Patients (3135) undergoing OA by more than 350 physicians at over 200 US institutions were enrolled on an “all-comers” basis, resulting in registries that provided site-reported patient demographics, ABI, Rutherford classification, co-morbidities, lesion characteristics, plaque morphology, device usage parameters, and procedural outcomes. RESULTS: Treatment with OA reduced pre-procedural stenosis from an average of 88–35%. Final residual stenosis after adjunctive treatments, typically low-pressure percutaneous transluminal angioplasty (PTA), averaged 10%. Plaque removal was most effective for severely calcified lesions and least effective for soft plaque. Shorter spin times and smaller crown sizes significantly lowered procedural complications which included slow flow (4.4%), embolism (2.2%), and spasm (6.3%), emphasizing the importance of treatment regimens that focus on plaque modification over maximizing luminal gain. CONCLUSION: The OA technique optimization, which resulted in a change of device usage across the CONFIRM registry series, corresponded to a lower incidence of adverse events irrespective of calcium burden or co-morbidities. © 2013 The Authors. Wiley Periodicals, Inc.
format Online
Article
Text
id pubmed-4158859
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher Blackwell Publishing Ltd
record_format MEDLINE/PubMed
spelling pubmed-41588592014-09-22 Technique Optimization of Orbital Atherectomy in Calcified Peripheral Lesions of the Lower Extremities: The CONFIRM Series, A Prospective Multicenter Registry Das, Tony Mustapha, Jihad Indes, Jeffrey Vorhies, Robert Beasley, Robert Doshi, Nilesh Adams, George L Catheter Cardiovasc Interv Peripheral Vascular Disease OBJECTIVES: The purpose of CONFIRM registry series was to evaluate the use of orbital atherectomy (OA) in peripheral lesions of the lower extremities, as well as optimize the technique of OA. BACKGROUND: Methods of treating calcified arteries (historically a strong predictor of treatment failure) have improved significantly over the past decade and now include minimally invasive endovascular treatments, such as OA with unique versatility in modifying calcific lesions above and below-the-knee. METHODS: Patients (3135) undergoing OA by more than 350 physicians at over 200 US institutions were enrolled on an “all-comers” basis, resulting in registries that provided site-reported patient demographics, ABI, Rutherford classification, co-morbidities, lesion characteristics, plaque morphology, device usage parameters, and procedural outcomes. RESULTS: Treatment with OA reduced pre-procedural stenosis from an average of 88–35%. Final residual stenosis after adjunctive treatments, typically low-pressure percutaneous transluminal angioplasty (PTA), averaged 10%. Plaque removal was most effective for severely calcified lesions and least effective for soft plaque. Shorter spin times and smaller crown sizes significantly lowered procedural complications which included slow flow (4.4%), embolism (2.2%), and spasm (6.3%), emphasizing the importance of treatment regimens that focus on plaque modification over maximizing luminal gain. CONCLUSION: The OA technique optimization, which resulted in a change of device usage across the CONFIRM registry series, corresponded to a lower incidence of adverse events irrespective of calcium burden or co-morbidities. © 2013 The Authors. Wiley Periodicals, Inc. Blackwell Publishing Ltd 2014-01-01 2013-06-04 /pmc/articles/PMC4158859/ /pubmed/23737432 http://dx.doi.org/10.1002/ccd.25046 Text en Copyright © 2013 The Authors. Wiley Periodicals, Inc. http://creativecommons.org/licenses/by-nc/3.0/ This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Peripheral Vascular Disease
Das, Tony
Mustapha, Jihad
Indes, Jeffrey
Vorhies, Robert
Beasley, Robert
Doshi, Nilesh
Adams, George L
Technique Optimization of Orbital Atherectomy in Calcified Peripheral Lesions of the Lower Extremities: The CONFIRM Series, A Prospective Multicenter Registry
title Technique Optimization of Orbital Atherectomy in Calcified Peripheral Lesions of the Lower Extremities: The CONFIRM Series, A Prospective Multicenter Registry
title_full Technique Optimization of Orbital Atherectomy in Calcified Peripheral Lesions of the Lower Extremities: The CONFIRM Series, A Prospective Multicenter Registry
title_fullStr Technique Optimization of Orbital Atherectomy in Calcified Peripheral Lesions of the Lower Extremities: The CONFIRM Series, A Prospective Multicenter Registry
title_full_unstemmed Technique Optimization of Orbital Atherectomy in Calcified Peripheral Lesions of the Lower Extremities: The CONFIRM Series, A Prospective Multicenter Registry
title_short Technique Optimization of Orbital Atherectomy in Calcified Peripheral Lesions of the Lower Extremities: The CONFIRM Series, A Prospective Multicenter Registry
title_sort technique optimization of orbital atherectomy in calcified peripheral lesions of the lower extremities: the confirm series, a prospective multicenter registry
topic Peripheral Vascular Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4158859/
https://www.ncbi.nlm.nih.gov/pubmed/23737432
http://dx.doi.org/10.1002/ccd.25046
work_keys_str_mv AT dastony techniqueoptimizationoforbitalatherectomyincalcifiedperipherallesionsofthelowerextremitiestheconfirmseriesaprospectivemulticenterregistry
AT mustaphajihad techniqueoptimizationoforbitalatherectomyincalcifiedperipherallesionsofthelowerextremitiestheconfirmseriesaprospectivemulticenterregistry
AT indesjeffrey techniqueoptimizationoforbitalatherectomyincalcifiedperipherallesionsofthelowerextremitiestheconfirmseriesaprospectivemulticenterregistry
AT vorhiesrobert techniqueoptimizationoforbitalatherectomyincalcifiedperipherallesionsofthelowerextremitiestheconfirmseriesaprospectivemulticenterregistry
AT beasleyrobert techniqueoptimizationoforbitalatherectomyincalcifiedperipherallesionsofthelowerextremitiestheconfirmseriesaprospectivemulticenterregistry
AT doshinilesh techniqueoptimizationoforbitalatherectomyincalcifiedperipherallesionsofthelowerextremitiestheconfirmseriesaprospectivemulticenterregistry
AT adamsgeorgel techniqueoptimizationoforbitalatherectomyincalcifiedperipherallesionsofthelowerextremitiestheconfirmseriesaprospectivemulticenterregistry