Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA; Vascular Center and Division of Cardiovascular Medicine, University of California, Davis, Sacramento, CA, USA.
Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA; Vascular Center and Division of Cardiovascular Medicine, University of California, Davis, Sacramento, CA, USA.
Cardiovasc Revasc Med. 2021 Feb;23:79-83. doi: 10.1016/j.carrev.2020.08.041. Epub 2020 Sep 11.
Infrapopliteal (IP) lesions are common in patients with critical limb ischemia (CLI). Optimal revascularization strategies including the use of adjunctive atherectomy have the potential to improve the outcomes for these patients.
To compare laser atherectomy (LA) vs. balloon angioplasty alone for the treatment of IP lesions in patients with CLI.
This was a two-center retrospective study of patients with CLI who underwent endovascular interventions for IP lesions. One and 2-year target lesion revascularization (TLR) was the primary outcome. One and 2-year limb loss and major adverse limb events (MALE) were secondary outcomes. Propensity score matching was performed. A Cox regression analysis was used to compare 1- and 2-year outcomes of the two groups. Logistic regression analysis was used to compare the two groups in terms of bail-out stenting and procedural complications.
A total of 313 patients with CLI were included; 76 were treated with LA. There was a high degree of lesion complexity in both groups. Consistent with the application of LA in the most complex lesions, lesions in the LA group were significantly longer (165.7 mm vs. 94.1 mm; p < 0.001) and were more frequently TASC C/D (82% vs. 45%; p < 0.001). In-stent restenosis (ISR) lesions were also more common among the LA group (14% vs. 0.4%; p < 0.001). Thrombotic lesions were present in 11% of the LA group vs. 4% in the no LA group (p = 0.04). CTOs were also more common in the LA group (58% vs. 43%; p = 0.024). After propensity matching, there was no difference in the 1 or 2-year TLR rates between the two groups. Similarly, there were no differences between the two groups in terms of 1 or 2-year limb loss or 2-year major adverse limb events.
LA is safe and effective for IP lesions in patients with CLI. There was a higher baseline angiographic complexity in patients treated with LA, suggesting that operators tend to use LA for the treatment of more complicated lesions. There was no difference among the two groups in 1- or 2-year outcomes of TLR of major amputation.
在患有严重肢体缺血（CLI）的患者中，腘下（IP）病变很常见。包括使用辅助旋切术在内的最佳血运重建策略有可能改善这些患者的预后。
比较激光旋切术（LA）与单纯球囊血管成形术治疗 CLI 患者的 IP 病变。
这是一项对在两个中心接受 IP 病变腔内介入治疗的 CLI 患者进行的回顾性研究。主要终点为 1 年和 2 年的靶病变血运重建（TLR）。次要终点为 1 年和 2 年的肢体丧失和主要不良肢体事件（MALE）。采用倾向评分匹配。采用 Cox 回归分析比较两组患者 1 年和 2 年的结局。采用 Logistic 回归分析比较两组患者的补救性支架置入和手术并发症。
共纳入 313 例 CLI 患者，其中 76 例接受 LA 治疗。两组患者的病变均具有较高的复杂性。与 LA 在最复杂病变中的应用一致，LA 组的病变长度明显更长（165.7mm vs. 94.1mm；p<0.001），TASC C/D 比例也更高（82% vs. 45%；p<0.001）。LA 组的支架内再狭窄（ISR）病变也更为常见（14% vs. 0.4%；p<0.001）。LA 组中血栓病变的比例为 11%，而无 LA 组为 4%（p=0.04）。LA 组中 CTO 也更为常见（58% vs. 43%；p=0.024）。经过倾向评分匹配后，两组患者 1 年或 2 年 TLR 率无差异。同样，两组患者在 1 年或 2 年肢体丧失或 2 年主要不良肢体事件方面也无差异。
LA 治疗 CLI 患者的 IP 病变是安全有效的。接受 LA 治疗的患者的基线血管造影复杂性更高，这表明术者倾向于使用 LA 治疗更为复杂的病变。两组患者 1 年或 2 年 TLR、主要截肢的结局均无差异。
