In this episode, host Dr. Aaron Fritts is joined by interventional cardiologists Dr. Sameh Sayfo (Baylor Scott & White in Plano, TX) and Dr. Nicolas Shammas (Cardiovascular Medicine in Davenport, IA) for a discussion about critical limb ischemia (CLI) and the use of lasers in below-the-knee (BTK) treatment.
To start, Dr. Shammas explains that infrapopliteal disease is difficult to treat due to the high rate of total occlusions and the high degree of medial calcinosis. Next, he gives an introduction to laser atherectomy for certain plaque locations and morphologies, and he describes previous studies that have shown its efficacy for calcified lesions. Intravascular ultrasound (IVUS) can also help guide vessel sizing, plaque morphology, and appropriate device selection. Dr. Shammas believes that the current atherectomy devices on the market are easy to learn to use and can be incorporated into any CLI program.
The doctors discuss the ongoing multicenter study on outcomes of the Auryon laser atherectomy system in CLI patients. Dr. Shammas reviews the study design, proposed endpoints, and current data on 30 day outcomes. We end the episode with advice on building a strong CLI program, which includes multidisciplinary collaboration, advocating for resources, a variety of different tools, and appropriate management of cardiovascular risk factors.
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AngioDynamics Auryon System
https://www.auryon-system.com/
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SHOW NOTES
00:00 - Introduction
04:18 - Current Treatment Limitations for Infrapopliteal Disease
07:38 - Laser Atherectomy for Calcified Lesions
12:10 - Learning Curve for Laser Atherectomy Devices
15:38 - 30-Day Results of the Auryon BTK Study
23:35 - Technical Approach and Tools for Infrapopliteal Segments
29:00 - Upcoming Developments in CLI Treatment
31:33 - Advice for Building a CLI Program
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RESOURCES
Calcium 360 Trial:
https://pubmed.ncbi.nlm.nih.gov/22891826/
Auryon Laser Atherectomy System:
https://www.angiodynamics.com/product/auryon/
Nexcimer Laser Atherectomy System:
https://www.usa.philips.com/healthcare/product/HCIGTDPHLLSRSYSTM/laser-system-hcigtdphllsrsystm
30-Day Results of the Auryon BTK Study:
https://www.jacc.org/doi/10.1016/j.jacc.2023.09.194
Midwest Cardiovascular Research Foundation:
http://www.mcrfmd.com/
Life-BTK Study:
https://www.cardiovascular.abbott/us/en/patients/treatments-therapies/peripheral-artery-disease/life-btk.html
Promise II Study:
https://www.nejm.org/doi/full/10.1056/NEJMoa2212754
BackTable Ep. 350- Building a CLI Program with Dr. Zola N’Dandu:
https://www.backtable.com/shows/vi/podcasts/350/building-a-cli-program
BackTable Vascular & Interventional