title: Impact of lesion location on procedural and acute angiographic outcomes in patients with critical limb ischemia treated for peripheral artery disease with orbital atherectomy: A CONFIRM registries subanalysis.
abstract: OBJECTIVE
  This analysis compares the procedural and acute angiographic outcomes in patients with critical limb ischemia (CLI) treated with orbital atherectomy in above-the-knee (ATK)/popliteal (POP) lesions versus below-the-knee (BTK) lesions.
  
  
  BACKGROUND
  Lesion location affects the procedural outcomes and the opportunity for limb salvage in patients with CLI suffering from peripheral artery disease (PAD).
  
  
  METHODS
  The CONFIRM registry series was analyzed and includes 1109 real-world patients (1544 lesions) suffering from CLI treated with orbital atherectomy. The rates of dissection, perforation, slow flow, vessel closure, spasm, embolism, and thrombus formation were compared between CLI patients with ATK/POP lesions and BTK lesions.
  
  
  RESULTS
  Patients with ATK/POP lesions had a higher final residual stenosis (10 vs. 9%; P = 0.004) and use of more adjunctive therapies (e.g. balloons and stents; 1.3 vs. 1.1%; P < 0.001) compared to patients with BTK lesions. Patients with BTK had higher incidence of perforation (1.5 vs. 0.2%; P = 0.005), slow flow (7.7 vs. 5.0%; P = 0.03) and spasm (10.3 vs. 4.2%; P < 0.001) but lower incidence of embolism (0.4 vs. 5.1%; P < 0.001).
  
  
  CONCLUSIONS
  Plaque modification with orbital atherectomy was successful in CLI patients regardless of lesion location. BTK lesions were associated with increased rates of perforation, slow flow and spasm which may be explained by more challenging procedural characteristics in these patients such as smaller vessel size and tortuosity. The higher incidence of emboli in ATK/POP lesions is most likely attributed to the higher prevalence of severe calcium observed in this cohort.
authors.affiliation: UCLA Medical Center, Los Angeles, CA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Metro Health Hospital, Wyoming, MI.
authors.forename: Jihad
authors.initials: J
authors.lastname: Mustapha
authors.affiliation: Mount Sinai Medical Center, Miami Beach, FL.
authors.forename: Robert
authors.initials: R
authors.lastname: Beasley
authors.affiliation: Midwest Institute for Minimally Invasive Therapies, Chicago, IL.
authors.forename: Paramjit
authors.initials: P
authors.lastname: Chopra
authors.affiliation: Cardiology and Interventional Vascular Associates, Dallas, TX.
authors.forename: Tony
authors.initials: T
authors.lastname: Das
authors.affiliation: Rex Healthcare, Raleigh, NC.
authors.forename: George L
authors.initials: GL
authors.lastname: Adams
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000295:instrumentation; D001157:Arterial Occlusive Diseases / Q000453:epidemiology; D017073:Atherectomy / Q000009:adverse effects / Q000379:methods*; D003251:Constriction, Pathologic; D016638:Critical Illness; D004617:Embolism / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D058226:Plaque, Atherosclerotic; D011150:Popliteal Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015995:Prevalence; D012039:Regional Blood Flow; D012042:Registries; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D057772:Vascular System Injuries / Q000453:epidemiology
keywords: ATK; BTK; atherectomy; critical limb ischemia; peripheral artery disease; vascular calcification