title: An Algorithm for the Use of Embolic Protection During Atherectomy for Femoral Popliteal Lesions.
abstract: This study sought to identify an algorithm for the use of distal embolic protection on the basis of angiographic lesion morphology and vascular anatomy for patients undergoing atherectomy for femoropopliteal lesions.
  
  
  
  Atherectomy has been shown to create more embolic debris than angioplasty alone. Distal embolic protection has been shown to be efficacious in capturing macroemboli; however, no consensus exists for the appropriate lesions to use distal embolic protection during atherectomy.
  
  
  
  Patients with symptomatic lower extremity peripheral artery disease treated with atherectomy and distal embolic protection were evaluated to identify potential predictors of DE. Plaque collected from the SilverHawk nose cone subset was sent to pathology for analysis to evaluate the accuracy of angiography in assessing plaque morphology.
  
  
  
  Significant differences were found in lesion length (142.1 ± 62.98 vs. 56.91 ± 41.04; p = 0.0001), low-density lipoprotein (82.3 ± 40.3 vs. 70.9 ± 23.2; p = 0.0006), vessel runoff (1.18 ± 0.9 vs. 1.8 ± 0.9; p = 0.0001), chronic total occlusion (131 vs. 10; p = 0.001), in-stent restenosis (33 vs. 6; p = 0.0081), and calcified lesions (136 vs. 65; p < 0.001). In simple logistic regression analysis lesion length, reference vessel diameter, chronic total occlusion, runoff vessels, and in-stent restenosis were found to be strongly associated with macroemboli. Angiographic assessment of plaque morphology was accurate. Positive predictive value of 92.31, negative predictive value of 95.35, sensitivity of 92.31, and specificity of 95.35 for calcium; positive predictive value of 95.56, negative predictive value of 100, sensitivity of 100, and specificity of 92.31 for atherosclerotic plaque. Thrombus/in-stent restenosis was correctly predicted.
  
  
  
  Chronic total occlusion, in-stent restenosis, thrombotic, calcific lesions >40 mm, and atherosclerotic lesions >140 mm identified by peripheral angiography necessitate concomitant filter use during atherectomy to prevent embolic complications.
authors.affiliation: Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York. Electronic address: prakash.krishnan@mountsinai.org.
authors.forename: Prakash
authors.initials: P
authors.lastname: Krishnan
authors.affiliation: Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York.
authors.forename: Arthur
authors.initials: A
authors.lastname: Tarricone
authors.affiliation: Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York.
authors.forename: K Raman
authors.initials: KR
authors.lastname: Purushothaman
authors.affiliation: Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York.
authors.forename: Meerarani
authors.initials: M
authors.lastname: Purushothaman
authors.affiliation: Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York.
authors.forename: Miguel
authors.initials: M
authors.lastname: Vasquez
authors.affiliation: Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York.
authors.forename: Jason
authors.initials: J
authors.lastname: Kovacic
authors.affiliation: Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York.
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.affiliation: Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York.
authors.forename: Vishal
authors.initials: V
authors.lastname: Kapur
authors.affiliation: Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York.
authors.forename: Karthik
authors.initials: K
authors.lastname: Gujja
authors.affiliation: Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York.
authors.forename: Annapoorna
authors.initials: A
authors.lastname: Kini
authors.affiliation: Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York.
authors.forename: Samin
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000792:Angiography; D017073:Atherectomy / Q000009:adverse effects / Q000295:instrumentation*; D001706:Biopsy; D002908:Chronic Disease; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D057505:Embolic Protection Devices; D004617:Embolism / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D058226:Plaque, Atherosclerotic; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D012008:Recurrence; D012307:Risk Factors; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*
keywords: atherectomy; embolic protection; peripheral artery disease