{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:11:25Z","timestamp":1792782685170,"version":"4.5.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Melbourne Health","id":[{"id":"https:\/\/ror.org\/04z4kmw33","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cardiovasc Intervent Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This systematic review and meta-analysis compares the safety and efficacy of atherectomy as a vessel preparation tool prior to balloon angioplasty (ATH\u2009+\u2009BA) versus balloon angioplasty alone (BA) for the treatment of peripheral arterial disease (PAD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Medline, Embase, CENTRAL, and Clinicaltrials.gov databases were searched for randomized controlled trials (RCTs) comparing ATH\u2009+\u2009BA versus BA alone in treating PAD. The outcomes analysed included primary patency, technical success, bailout stenting, flow-limiting dissection, clinically driven target lesion revascularization (CD-TLR), distal embolization, arterial perforation, major amputation, and all-cause mortality. A subgroup analysis was done to compare femoropopliteal versus infrapopliteal and plain balloon angioplasty versus drug-coated balloon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seven RCTs met the inclusion criteria (489 patients). Atherectomy as vessel preparation was associated with reduced rates of bailout stenting (OR: 0.14, 95% CI 0.03\u20130.67,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01) and flow-limiting dissection (OR: 0.29, 95% CI 0.10\u20130.84,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). Primary patency (OR: 2.13, 95% CI 1.00\u20134.50,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.049) and CD-TLR at 6\u00a0months (OR: 0.24, 95% CI 0.06\u20130.96,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04) results favoured ATH\u2009+\u2009BA. No significant differences were found in technical success, 12-month primary patency, CD-TLR at 12\u00a0months, distal embolization, arterial perforation, major amputation, or all-cause mortality. Subgroup analysis demonstrated a reduction in bailout stenting in femoropopliteal studies (OR: 0.05, 95% CI 0.01\u20130.21) compared with infrapopliteal studies (OR: 0.86, 95% CI 0.31\u20132.40).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This meta-analysis found that atherectomy as vessel preparation prior to BA reduced bailout stenting, flow-limiting dissections, and 6-month CD-TLR, with improved 6-month patency compared with BA alone. However, these benefits did not translate into improvements in clinical outcomes at 12\u00a0months. Larger RCTs are needed to establish the clinical benefit of atherectomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00270-026-04527-y","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T20:45:29Z","timestamp":1783975529000},"page":"1657-1666","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Paving the Way: a Systematic Review and Meta-Analysis of Randomized Controlled Trials of Atherectomy as Vessel Preparation Prior to Balloon Angioplasty in Peripheral Arterial Disease"],"prefix":"10.1007","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2104-7464","authenticated-orcid":false,"given":"Joshua Qi Jing","family":"Ho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonal","family":"Udayasiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Stewart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andy","family":"Owen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Numan","family":"Kutaiba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessie","family":"Low","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Khabaza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinesh","family":"Ranatunga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Maingard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Brooks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashu","family":"Jhamb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Corlette","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Handley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christen","family":"Barras","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong Kuan","family":"Kok","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamed","family":"Asadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"issue":"12","key":"4527_CR1","doi-asserted-by":"publisher","first-page":"1818","DOI":"10.1161\/CIRCRESAHA.121.318535","volume":"128","author":"AW Aday","year":"2021","unstructured":"Aday AW, Matsushita K. Epidemiology of peripheral artery disease and polyvascular disease. Circ Res. 2021;128(12):1818\u201332. https:\/\/doi.org\/10.1161\/CIRCRESAHA.121.318535.","journal-title":"Circ Res"},{"issue":"6S","key":"4527_CR2","doi-asserted-by":"publisher","first-page":"3S","DOI":"10.1016\/j.jvs.2019.02.016","volume":"69","author":"MS Conte","year":"2019","unstructured":"Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019;69(6S):3S-125S.e40. https:\/\/doi.org\/10.1016\/j.jvs.2019.02.016.","journal-title":"J Vasc Surg"},{"issue":"2","key":"4527_CR3","doi-asserted-by":"publisher","first-page":"89","DOI":"10.23736\/S0021-9509.19.11037-3","volume":"38","author":"M Bosiers","year":"2019","unstructured":"Bosiers M. The evolution of balloon angioplasty for peripheral artery disease. Int Angiol. 2019;38(2):89\u201396. https:\/\/doi.org\/10.23736\/S0021-9509.19.11037-3.","journal-title":"Int Angiol"},{"issue":"2","key":"4527_CR4","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012542","volume":"2017","author":"L Robertson","year":"2017","unstructured":"Robertson L, Paraskevas KI, Stewart M. Angioplasty and stenting for peripheral arterial disease of the lower limbs: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017;2017(2):CD012542. https:\/\/doi.org\/10.1002\/14651858.CD012542.","journal-title":"Cochrane Database Syst Rev"},{"key":"4527_CR5","doi-asserted-by":"publisher","first-page":"305","DOI":"10.2147\/VHRM.S81122","volume":"12","author":"M Herten","year":"2016","unstructured":"Herten M, Torsello G, Schonfield E, et al. Drug-coated balloons for femoropopliteal arterial disease: current status and future perspectives. Vasc Health Risk Manag. 2016;12:305\u201320. https:\/\/doi.org\/10.2147\/VHRM.S81122.","journal-title":"Vasc Health Risk Manag"},{"issue":"2","key":"4527_CR6","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/j.iccl.2019.12.004","volume":"9","author":"MT Finn","year":"2020","unstructured":"Finn MT, Ingrassia JJ, Gray WA. Review of atherectomy for the treatment of peripheral artery disease. Interv Cardiol Clin. 2020;9(2):221\u201330. https:\/\/doi.org\/10.1016\/j.iccl.2019.12.004.","journal-title":"Interv Cardiol Clin"},{"issue":"5","key":"4527_CR7","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/j.jcin.2024.11.038","volume":"18","author":"G Korosoglou","year":"2025","unstructured":"Korosoglou G, Schmidt A, Lichtenberg M, Malyar N, Stavroulakis K, Reinecke H, et al. Global algorithm for the endovascular treatment of chronic femoropopliteal lesions: an interdisciplinary expert opinion statement. JACC Cardiovasc Interv. 2025;18(5):545\u201357. https:\/\/doi.org\/10.1016\/j.jcin.2024.11.038.","journal-title":"JACC Cardiovasc Interv"},{"key":"4527_CR8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https:\/\/doi.org\/10.1136\/bmj.n71.","journal-title":"BMJ"},{"key":"4527_CR9","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898","volume":"366","author":"JAC Sterne","year":"2019","unstructured":"Sterne JAC, Savovi\u0107 J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. https:\/\/doi.org\/10.1136\/bmj.l4898.","journal-title":"BMJ"},{"issue":"8","key":"4527_CR10","first-page":"355","volume":"26","author":"R Dattilo","year":"2014","unstructured":"Dattilo R, Himmelstein SI, Cuff RF. The COMPLIANCE 360\u00b0 trial: a randomized, prospective, multicenter, pilot study comparing acute and long-term results of orbital atherectomy to balloon angioplasty for calcified femoropopliteal disease. J Invasive Cardiol. 2014;26(8):355\u201360 (PMID: 25091093).","journal-title":"J Invasive Cardiol"},{"issue":"9","key":"4527_CR11","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.116.004848","volume":"10","author":"T Zeller","year":"2017","unstructured":"Zeller T, Langhoff R, Rocha-Singh KJ, et al. Directional atherectomy followed by a paclitaxel-coated balloon to inhibit restenosis and maintain vessel patency: twelve-month results of the DEFINITIVE AR study. Circ Cardiovasc Interv. 2017;10(9):e004848. https:\/\/doi.org\/10.1161\/CIRCINTERVENTIONS.116.004848.","journal-title":"Circ Cardiovasc Interv"},{"key":"4527_CR12","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/j.avsg.2019.06.014","volume":"64","author":"Z Cai","year":"2020","unstructured":"Cai Z, Guo L, Qi L, Cui S, Tong Z, Guo J, et al. Midterm outcome of directional atherectomy combined with drug-coated balloon angioplasty versus drug-coated balloon angioplasty alone for femoropopliteal arteriosclerosis obliterans. Ann Vasc Surg. 2020;64:181\u20137. https:\/\/doi.org\/10.1016\/j.avsg.2019.06.014.","journal-title":"Ann Vasc Surg"},{"key":"4527_CR13","doi-asserted-by":"publisher","first-page":"603","DOI":"10.2147\/VHRM.S371177","volume":"18","author":"NW Shammas","year":"2022","unstructured":"Shammas NW, Purushottam B, Shammas WJ, et al. Jetstream atherectomy followed by paclitaxel-coated balloons versus balloon angioplasty followed by paclitaxel-coated balloons: twelve-month exploratory results of the prospective randomized JET-RANGER study. Vasc Health Risk Manag. 2022;18:603\u201315. https:\/\/doi.org\/10.2147\/VHRM.S371177.","journal-title":"Vasc Health Risk Manag"},{"issue":"20 Suppl 1","key":"4527_CR14","first-page":"B154","volume":"58","author":"NW Shammas","year":"2012","unstructured":"Shammas NW, Lam R, Mustapha J, et al. Six-month outcomes of the CALCIUM 360 study: orbital atherectomy versus balloon angioplasty for the treatment of calcified infrapopliteal arterial disease. J Am Coll Cardiol. 2012;58(20 Suppl 1):B154.","journal-title":"J Am Coll Cardiol"},{"issue":"6","key":"4527_CR15","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.120.010280","volume":"14","author":"A Rastan","year":"2021","unstructured":"Rastan A, Brodmann M, B\u00f6hme T, et al. Atherectomy and drug-coated balloon angioplasty for the treatment of long infrapopliteal lesions: a randomized controlled trial. Circ Cardiovasc Interv. 2021;14(6):e010280. https:\/\/doi.org\/10.1161\/CIRCINTERVENTIONS.120.010280.","journal-title":"Circ Cardiovasc Interv"},{"issue":"6","key":"4527_CR16","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1177\/15266028211070968","volume":"29","author":"T Zeller","year":"2022","unstructured":"Zeller T, Giannopoulos S, Brodmann M, et al. Orbital atherectomy prior to drug-coated balloon angioplasty in calcified infrapopliteal lesions: a randomized, multicenter pilot study. J Endovasc Ther. 2022;29(6):874\u201384. https:\/\/doi.org\/10.1177\/15266028211070968.","journal-title":"J Endovasc Ther"},{"issue":"2","key":"4527_CR17","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/j.jvs.2008.02.029","volume":"48","author":"A Nikanorov","year":"2008","unstructured":"Nikanorov A, Smouse HB, Osman K, Bialas M, Ragheb AO, Scheinert D. Fracture of self-expanding nitinol stents stressed in vitro under simulated intravascular conditions. J Vasc Surg. 2008;48(2):435\u201340. https:\/\/doi.org\/10.1016\/j.jvs.2008.02.029.","journal-title":"J Vasc Surg"},{"issue":"2","key":"4527_CR18","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.114.002376","volume":"9","author":"MI Spreen","year":"2016","unstructured":"Spreen MI, Martens JM, Hansen BE, Knippenberg B, Verhey E, van Dijk LC, et al. Percutaneous transluminal angioplasty and drug-eluting stents for infrapopliteal lesions in critical limb ischemia (PADI) trial. Circ Cardiovasc Interv. 2016;9(2):e002376. https:\/\/doi.org\/10.1161\/CIRCINTERVENTIONS.114.002376.","journal-title":"Circ Cardiovasc Interv"},{"key":"4527_CR19","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD006680.pub4","author":"S Pherwani","year":"2026","unstructured":"Pherwani S, Gendia A, Sen S, Ambler GK, Hinchliffe RJ, Twine CP. Atherectomy for peripheral arterial disease. Cochrane Database Syst Rev. 2026. https:\/\/doi.org\/10.1002\/14651858.CD006680.pub4.","journal-title":"Cochrane Database Syst Rev"},{"issue":"5","key":"4527_CR20","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1016\/j.ejvs.2024.08.002","volume":"68","author":"WK Yiu","year":"2024","unstructured":"Yiu WK, Cheng SW, Hung EHY, Yim KF, Lo SF, Fung GSK. Systematic review and network meta-analysis of vessel preparation techniques with plain balloon angioplasty, atherectomy, or intravascular lithotripsy before application of a drug coated balloon to treat atherosclerotic femoropopliteal disease. Eur J Vasc Endovasc Surg. 2024;68(5):608\u201322. https:\/\/doi.org\/10.1016\/j.ejvs.2024.08.002.","journal-title":"Eur J Vasc Endovasc Surg"}],"container-title":["CardioVascular and Interventional Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00270-026-04527-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00270-026-04527-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00270-026-04527-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T15:35:11Z","timestamp":1790091311000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00270-026-04527-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,13]]},"references-count":20,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["4527"],"URL":"https:\/\/doi.org\/10.1007\/s00270-026-04527-y","relation":{},"ISSN":["1432-086X"],"issn-type":[{"value":"1432-086X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,13]]},"assertion":[{"value":"23 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that they have no relevant fi nancial or non-fi nancial interests to disclose.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}