BackTable Vascular & Interventional

Ep. 408 Laser BTK Study Insights: Navigating Complex Lesions with Dr. Nicolas Shammas

Jan 23, 2024

Dr. Sameh Sayfo and Dr. Nicolas Shammas discuss critical limb ischemia (CLI) and the use of lasers in below-the-knee (BTK) treatment. They explain the challenges of treating infrapopliteal disease and the efficacy of laser atherectomy for calcified lesions. The ongoing multicenter study on the Auryon laser atherectomy system in CLI patients is reviewed, along with advice on building a strong CLI program.

40:39

Episode guests

Nicolas Shammas

Sameh Sayfo

AI Summary

AI Chapters

Episode notes

Podcast summary created with Snipd AI

Quick takeaways

Laser atherectomy has become an important modality in vessel prepping for below-the-knee (BTK) interventions due to its efficacy in treating fibro-calcific and calcific lesions.

Building a successful CLI program requires a collaborative, multi-disciplinary approach involving endovascular specialists, vascular surgeons, wound specialists, administrative support, and comprehensive patient care beyond revascularization.

Deep dives

Overview of the podcast episode

In this episode of the VACTIM podcast, Dr. Nicholas Shamos discusses the status of laser atherectomy in the treatment of below-the-knee (BTK) chronic limb ischemia (CLI) disease. He highlights the challenges and limitations of current treatments for infrapopliteal disease, such as balloon angioplasty, and explores why laser atherectomy has become an important modality in vessel prepping for BTK interventions. Dr. Shamos provides insights into the physical properties of the laser device, specifically the Orion laser from AngioDynamics, and how it offers advantages in treating fibro-calcific and calcific lesions. He shares the positive results and safety outcomes of the ongoing Aryan below-the-knee study, emphasizing the importance of long-term follow-up to evaluate limb salvage and primary patency. Dr. Shamos also discusses the need for a collaborative, multi-disciplinary approach in building a successful CLI program, including the involvement of endovascular specialists, vascular surgeons, wound specialists, and other key members. He highlights the importance of administrative buy-in and resource allocation to support the program, and emphasizes the significance of comprehensive patient care beyond revascularization, including pharmacologic management and lifestyle interventions for cardiovascular risk reduction.

Introduction

5min

The Use of Laser in Treating Below the Knee Lesions

9min

Use of Lasers and Intravascular Ultrasound (IVUS) in Treating Complex Lesions Below the Knee

4min

Follow-up Process and Study Endpoints

4min

Complexity of Below the Knee Vessels in Peripheral Interventions

18min

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.

---

CHECK OUT OUR SPONSOR

AngioDynamics Auryon System

https://www.auryon-system.com/

---

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

---

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

Remember Everything You Learn from Podcasts

Save insights instantly, chat with episodes, and build lasting knowledge - all powered by AI.