Percutaneous angioplasty versus atherectomy for treatment of symptomatic infra-popliteal arterial disease

Background Outcomes for debulking by atherectomy (ATH) for adjunctive treatment of below the knee (BTK) symptomatic arterial disease compared to percutaneous transluminal angioplasty alone (PTA) are unclear. Methods MEDLINE, EMBASE, PubMed and the Cochrane Central Register of Controlled Trials were queried from between 2000 and 2017 including studies comparing PTA alone to PTA-ATH. Random effect meta-analysis model was used to pool the data across the studies. Study endpoints included: vessel dissection, residual stenosis ( 30%), mortality at 12 months and amputation rates at 1 and 12 months. Results A total of 2587 patients (72.9 years; 63% male) were included from 4 studies (2 prospective, one of which was randomized, and 2 retrospective) comparing PTA alone to ATH-PTA in patients with symptomatic infra-popliteal disease. There was no significant difference between the two approaches in terms of vessel dissection [OR 3.73 with 95% CI 0.83 to 16.64, p = 0.08] or residual stenosis [OR 0.41 with 95% CI 0.11 to 1.60, p = 0.18]. Clinical outcomes did not differ in terms of 12 month mortality [OR 3.47 with 95% CI 0.15 to 81.37, p = 0.44], or limb amputation at 1 month [OR 1.23 with 95% CI 0.91 to 1.67, p = 0.18] or 12 months [OR: 1.02 with 95% CI 0.83 to 1.26, p = 0.83]. Conclusion In patients undergoing (BTK) intervention, PTA alone and ATH-PTA was associated with similar outcomes in terms of vessel dissection and residual stenosis, mortality at 12 months, and limb amputation at 1 or 12 months.