Endovascular Atherectomy in Peripheral Artery Disease, Coronary Artery Disease, and Non-Atherosclerotic Vascular Conditions: Scoping Review with ☸️SAIMSARA

Name: SAIMSARA Evidence Object vascular::ENDOVASCULAR_ATHERECTOMY_PM
Creator: SAIMSARA
License: https://saimsara.com/license/

SAIMSARA

doi:10.62487/saimsara99fa2e74

SAIMSARA Journal

Machine-Readable Science • ISSN 3054-3991

Endovascular Atherectomy in Peripheral Artery Disease, Coronary Artery Disease, and Non-Atherosclerotic Vascular Conditions: Scoping Review with ☸️SAIMSARA

Cardiac & Vascular Health

Issue 1, Volume 1, 2026

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DOI: 10.62487/saimsara99fa2e74

Editorial note

• Last update: 2026-06-20 10:43:41

What is this paper about

Endovascular atherectomy delivers high technical success across peripheral, coronary, and selected non-atherosclerotic vascular conditions, yet its long-term clinical advantage remains highly dependent on anatomy, device, and treatment strategy. The full review reveals where atherectomy adds real value, where risks and reinterventions rise, and which applications remain unsupported.

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Abstract: To comprehensively map the clinical evidence on endovascular atherectomy across peripheral artery disease, coronary artery disease, and non-atherosclerotic vascular conditions, synthesizing data on technical success, clinical outcomes, reintervention, and safety across different devices, anatomical segments, and clinical indications, while also characterizing practice patterns and health-system implications. The review uses 172 references and builds its evidence map from 302 original studies with 1732527 total participants/sample observations (topic-deduplicated ΣN). This scoping review indicates that endovascular atherectomy reliably achieves high acute technical success in complex, calcified lesions but does not consistently translate into superior long-term outcomes compared with angioplasty or stenting, with adjusted safety endpoints showing no significant difference (aHR 0.99). The evidence supports a role for atherectomy chiefly as a lesion-preparation adjunct to drug-coated balloon therapy rather than a standalone strategy, while highlighting a replicated trade-off of increased reintervention (aHR 1.21) and elevated distal embolization. A more favorable signal emerges in isolated popliteal disease, where atherectomy was associated with higher freedom from major amputation. These patterns, alongside utilization shifts toward office-based settings driven by non-clinical factors, warrant scrutiny of appropriateness. Randomized trials with standardized endpoints are needed to clarify where selective atherectomy genuinely improves limb outcomes.
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Keywords: endovascular atherectomy; peripheral artery disease; femoropopliteal lesions; drug-coated balloon; target lesion revascularization; major adverse limb events; rotational atherectomy; in-stent restenosis; chronic limb-threatening ischemia; below-the-knee intervention

Review Stats

Final search date and database lock: 2026-06-05 07:36:34 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 576
Downloaded Abstracts/Papers: 576
Included original and non-original Abstracts/Papers (all): 448
Included original Abstracts/Papers (Vote counting by direction of effect): 302
Reference Index (links used in paper): 172
Total participants/sample observations (topic deduplicated ΣN): 1732527

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Reference Index (172)

[1] Global Algorithm for the Endovascular Treatment of Chronic Femoropopliteal Lesions: An Interdisciplinary Expert Opinion Statement. — https://doi.org/10.1016/j.jcin.2024.11.038
[2] Atherectomy-assisted endovascular therapy versus open repair for atherosclerotic common femoral artery disease: The multicenter ARISTON study. — https://doi.org/10.1177/1358863x251323508
[3] Long-term outcomes of peripheral atherectomy for femoropopliteal endovascular interventions. — https://doi.org/10.4244/eij-d-22-00609
[4] The Endovascular Therapy Using Excimer Laser Atherectomy for Complex Femoropopliteal In-Stent Restenosis Lesions. — https://doi.org/10.1177/15266028251363466
[5] Atherectomy vs Other Modalities for Treatment During Peripheral Vascular Intervention. — https://doi.org/10.1007/s11886-022-01709-1
[6] Comparison of Different Endovascular Treatments of Femoropopliteal Artery In-Stent Restenosis: A Systematic Review and Bayesian Network Meta-Analysis. — https://doi.org/10.1016/j.avsg.2023.12.081
[7] Atherectomy in below-the-knee endovascular interventions: One-year outcomes from the XLPAD registry. — https://doi.org/10.1002/ccd.27897
[8] Midterm outcomes of rotational atherectomy-assisted endovascular treatment of severe peripheral arterial disease. — https://doi.org/10.1016/j.jvs.2023.12.030

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