0915_Brodmann.pdf

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1、When Do I Choose IVL Over Atherectomy in BTK Lesion?Marianne Brodmann,MDDivision of Angiology,Medical University Graz,AustriaBTK disease BTK disease is prevalent in CLTI,particularly in the diabetic population,70%BTK disease can be challenging due to anatomical/lesion characteristics Plaque Morpholo

2、gy:one progresses caudally into the tibial arteries,calcium plaques increase with a concurrent decrease in fibrofatty plaques 1 medial calcification occurred with more frequency in infrapopliteal arteries 2Important implication on treatment modality1 Bishop PD,et al.Ann Vasc Surg.2008;22:799805.2 Na

3、rula N,et al.J Am Coll Cardiol.2018;72:21522163.BTK disease/Treatment Balloon angioplasty alone remains limited by poor midterm patency rates,although appropriate one-to-one sizing of angioplasty balloons and prolonged inflations has shown better acute luminal gain and less recoil Specialty balloons

4、 provide a more controlled dilation,however robust evidence to support that theory is not yet available in the crural arteries1-3 Atherectomy and intravascular lithotripsy(IVL)may be options for non-dilatable BTK arteries 1 Ansel GM,Sample NS,Botti CF et al.Cath Cardiovasc Intervent 2004;61:1-4.2 Wa

5、rd C,Mena-Hurtado C.Endovascular Today 2014:24-8.3 Bosiers M,Deloose K,Cagiannos C,Verbist J,Peeters P.Vascular 2009;17:29-35.Atherectomy and BTK Systematic Review and Network Meta-analysis 23 studies including 3091 patients treated with PTA,DCB,DES,BMS,BVS and atherectomyTirziu D et al;J Endovasc T

6、her.2025 Jun 30:15266028251344809.doi:10.1177/15266028251344809.Online ahead of print.SafetyAtherectomy/IVL BTK Scoping Review 15 studies comprising 5450 patients were included in this review,with vessel preparation performed in 2179 cases(40%)2 of the 15 studies evaluated intravascular lithotripsy