title: Immediate and intermediate-term results of optical coherence tomography guided atherectomy in the treatment of peripheral arterial disease: Initial results from the VISION trial.
abstract: BACKGROUND
  Long-term patency rates for percutaneous peripheral arterial interventions are suboptimal. Optical coherence tomography (OCT) guided atherectomy may yield superior patency by optimizing plaque removal while preserving the tunica media and adventitia.
  
  
  METHODS
  The VISION study is a multicenter prospective study of patients with peripheral arterial disease undergoing OCT guided atherectomy with the Pantheris™ device. In 11 patients enrolled in a single center, we report procedural and clinical outcomes, at 30days and 6months.
  
  
  RESULTS
  The mean age was 63±11years and 73% (n=8) were men. The target lesion was in the superficial femoral artery in 82% (n=9) of the patients. Mean stenosis severity was 87%±10% and mean lesion length was 39±31mm. Procedural success was observed in all patients with no device related complications. Mean post-atherectomy stenosis was 18%±15%. Almost all excised tissue consisted of intimal plaque (94%). At 30days, significant improvements in Rutherford class, VascuQoL scores and ABI were observed, 0.9±0.8 vs. 3.1±0.7 (p=0.01), 4.9±1.9 vs. 3.6±1.5 (p=0.03) and 1.04±0.19 vs. 0.80±0.19 (p<0.01) respectively. At 6months, there were significant improvements in Rutherford class (1.0±1.0 vs. 3.1±0.7, p=0.01) and ABI (0.93±0.19 versus 0.80±0.19, p=0.02) but not in VascuQoL scores (3.7±1.4 versus 3.6±1.5, p=0.48). Target lesion revascularization occurred in 18% (n=2) of the patients.
  
  
  CONCLUSIONS
  OCT guided atherectomy resulted in high procedural success, no device related complications and encouraging results up to 6months. Histological analysis suggested little injury to the media and adventitia. Larger studies are needed to confirm the efficacy of this approach.
authors.affiliation: Arkansas Heart Hospital, Peripheral Vascular Institute, Little Rock, AR, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Cawich
authors.affiliation: Arkansas Heart Hospital, Peripheral Vascular Institute, Little Rock, AR, USA.
authors.forename: Andre R M
authors.initials: AR
authors.lastname: Paixao
authors.affiliation: Citizens Memorial Heart and Vascular Institute, Bolivar, MO; University of Missouri, Columbia, MO.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Marmagkiolis
authors.affiliation: Arkansas Heart Hospital, Peripheral Vascular Institute, Little Rock, AR, USA.
authors.forename: Vasili
authors.initials: V
authors.lastname: Lendel
authors.affiliation: Arkansas Heart Hospital, Peripheral Vascular Institute, Little Rock, AR, USA.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Rodriguez-Araujo
authors.affiliation: Arkansas Heart Hospital, Peripheral Vascular Institute, Little Rock, AR, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Rollefson
authors.affiliation: Arkansas Heart Hospital, Peripheral Vascular Institute, Little Rock, AR, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Mego
authors.affiliation: Arkansas Heart Hospital, Peripheral Vascular Institute, Little Rock, AR, USA; Koc University, School of Medicine, Istanbul, Turkey. Electronic address: Cilingiroglumehmet@gmail.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Cilingiroglu
mesh_terms: D000368:Aged; D000792:Angiography; D017073:Atherectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D003251:Constriction, Pathologic; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: Atherectomy; Optical coherence tomography; Peripheral arterial disease