{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T23:07:29Z","timestamp":1779923249283,"version":"3.53.1"},"reference-count":50,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rofo"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Peripheral arterial disease (PAD) is a prevalent and increasingly common condition associated with high morbidity and a growing number of patients worldwide. Atherectomy, a minimally invasive technique to remove or modify atherosclerotic plaques, has gained popularity as an adjunct to vessel preparation before balloon angioplasty, particularly in combination with drug-coated balloons (DCB). Its therapeutic role in PAD appears promising but requires further investigation.<\/jats:p>\n                  <jats:p>A systematic literature search was conducted in the PubMed database. Randomized controlled trials, meta-analyses, registry data, and guideline recommendations regarding atherectomy in PAD were included. The aim was to evaluate evidence on efficacy, safety, and clinical relevance across different anatomical regions and different atherectomy devices.<\/jats:p>\n                  <jats:p>Atherectomy shows promise as an adjunctive technique in the endovascular treatment of PAD, particularly for complex and calcified lesions in the femoropopliteal segment. While some observational and registry data suggest improved procedural success, luminal gain and reduced need for bailout stenting, randomized controlled trials yield mixed results regarding long-term patency and clinical benefit. In below-the-knee interventions, evidence remains limited and complication rates are of concern.<\/jats:p>\n                  <jats:p>Overall, atherectomy represents a valuable tool within a tailored treatment approach but requires further clinical validation through high-quality trials to clearly define its therapeutic role.<\/jats:p>","DOI":"10.1055\/a-2718-7990","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T23:45:12Z","timestamp":1762904712000},"page":"736-745","source":"Crossref","is-referenced-by-count":0,"title":["The Role of Atherectomy in the Treatment of Peripheral Artery Disease"],"prefix":"10.1055","volume":"198","author":[{"given":"Matthias","family":"Limbrock","sequence":"additional","affiliation":[{"name":"Witten\/Herdecke University, NRW, Germany","place":["Witten"],"department":["Faculty of Health"]},{"name":"Niels-Stensen-Kliniken GmbH, NDS, Germany","place":["Osnabr\u00fcck"],"department":["Radiology\/Neuroradiology"]},{"name":"University of Applied Sciences Bremerhaven, Germany","place":["Bremerhaven"],"department":["Faculty of Technology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Sunderdiek","sequence":"additional","affiliation":[{"name":"Niels-Stensen-Kliniken GmbH, NDS, Germany","place":["Osnabr\u00fcck"],"department":["Radiology\/Neuroradiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Haage","sequence":"additional","affiliation":[{"name":"Witten\/Herdecke University, NRW, Germany","place":["Witten"],"department":["Faculty of Health"]},{"name":"HELIOS Universitatsklinikum Wuppertal, Nordrhein-Westfalen, Germany","place":["Wuppertal"],"department":["Diagnostic and Interventional Radiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph Alexander","family":"Stueckle","sequence":"additional","affiliation":[{"name":"Witten\/Herdecke University, NRW, Germany","place":["Witten"],"department":["Faculty of Health"]},{"name":"Niels-Stensen-Kliniken GmbH, NDS, Germany","place":["Osnabr\u00fcck"],"department":["Radiology\/Neuroradiology"]},{"name":"University of Applied Sciences Bremerhaven, Germany","place":["Bremerhaven"],"department":["Faculty of Technology"]},{"name":"HELIOS Universitatsklinikum Wuppertal, Nordrhein-Westfalen, Germany","place":["Wuppertal"],"department":["Diagnostic and Interventional Radiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1007\/s00059-024-05252-3","article-title":"Periphere arterielle Verschlusskrankheit (pAVK)","volume":"49","author":"C 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Wardle","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"133","DOI":"10.2147\/VHRM.S403177","article-title":"Jetstream Atherectomy with Paclitaxel-Coated Balloons: Two-Year Outcome of the Prospective Randomized JET-RANGER Study","volume":"19","author":"NW Shammas","year":"2023","journal-title":"Vasc Health Risk Manag"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1798","DOI":"10.1016\/S0140-6736(23)00462-2","article-title":"A vein bypass first versus a best endovascular treatment first revascularisation strategy for patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal revascularisation procedure to restore limb perfusion (BASIL-2): An open-label, randomised, multicentre, phase 3 trial","volume":"401","author":"AW Bradbury","year":"2023","journal-title":"Lancet"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1016\/j.jcin.2014.01.158","article-title":"Pivotal trial to evaluate the safety and efficacy of the orbital atherectomy system in treating de novo, severely calcified coronary lesions (ORBIT II)","volume":"7","author":"JW Chambers","year":"2014","journal-title":"JACC Cardiovasc Interv"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/j.carrev.2017.01.011","article-title":"Orbital atherectomy for treating de novo, severely calcified coronary lesions: 3-year results of the pivotal ORBIT II trial","volume":"18","author":"M Lee","year":"2017","journal-title":"Cardiovasc Revasc Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1055\/s-0034-1390083","article-title":"JETSTREAM Atherectomy: A Review of Technique, Tips, and Tricks in Treating the Femoropopliteal Lesions","volume":"24","author":"NW Shammas","year":"2015","journal-title":"Int J Angiol"},{"key":"ref10","first-page":"549","article-title":"Directional atherectomy before paclitaxel coated balloon angioplasty in complex femoropopliteal disease: The VIVA REALITY study","volume":"98","author":"KJ Rocha-Singh","year":"2021","journal-title":"Catheter Cardiovasc Interv"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"e432","DOI":"10.4244\/EIJ-D-21-01070","article-title":"Phoenix atherectomy for patients with peripheral artery disease","volume":"18","author":"S Giusca","year":"2022","journal-title":"EuroIntervention"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"287","DOI":"10.23736\/S0021-9509.23.12607-3","article-title":"ZILVERPASS Study: ZILVER PTX Stent vs Bypass Surgery in Femoropopliteal Lesions","volume":"27","author":"M Bosiers","year":"2020","journal-title":"J Endovasc 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Twelve-month safety and effectiveness results from the Zilver PTX single-arm clinical study","volume":"18","author":"MD Dake","year":"2011","journal-title":"J Endovasc Ther"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1161\/CIRCULATIONAHA.115.016900","article-title":"Durable Clinical Effectiveness With Paclitaxel-Eluting Stents in the Femoropopliteal Artery: 5-Year Results of the Zilver PTX Randomized Trial","volume":"133","author":"MD Dake","year":"2016","journal-title":"Circulation"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1016\/j.jcin.2021.01.026","article-title":"2-Year Outcomes of the Eluvia Drug-Eluting Stent for the Treatment of Complex Femoropopliteal Lesions","volume":"14","author":"K Stavroulakis","year":"2021","journal-title":"JACC Cardiovasc Interv"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.1016\/S0140-6736(18)32262-1","article-title":"A polymer-coated, paclitaxel-eluting 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Cardiol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1925","DOI":"10.1016\/S0140-6736(05)67704-5","article-title":"Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial","volume":"366","author":"DJ Adam","year":"2005","journal-title":"Lancet"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"2305","DOI":"10.1056\/NEJMoa2207899","article-title":"Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia","volume":"387","author":"A Farber","year":"2022","journal-title":"N Engl J Med"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.012081","article-title":"Adverse Events After Atherectomy: Analyzing Long-Term Outcomes of Endovascular Lower Extremity Revascularization Techniques","volume":"8","author":"N Ramkumar","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"ref36","article-title":"Insights From the FDA's MAUDE Database Regarding the Real-World Safety of Jetstream Atherectomy for Peripheral Arterial Disease","volume":"2023","author":"A Min","journal-title":"J Endovasc Ther"},{"key":"ref37","first-page":"330","article-title":"Safety and Effectiveness of the Nav-6 Filter in Preventing Distal Embolization During Jetstream Atherectomy of Infrainguinal Peripheral Artery Lesions","volume":"28","author":"A Banerjee","year":"2016","journal-title":"J Invasive Cardiol"},{"key":"ref38","doi-asserted-by":"crossref","DOI":"10.1155\/2021\/9047596","article-title":"Comparison and Analysis between the NAV6 Embolic Protection Filter and SpiderFX EPD Filter in Superficial Femoral Artery Lesions","volume":"2021","author":"P Krishnan","year":"2021","journal-title":"J Interv Cardiol"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1016\/j.ejvs.2022.10.014","article-title":"Jetstream Rotational Atherectomy and Drug Coated Balloon Angioplasty with In Stent Re-stenosis and Occlusions. A Two Centre Study","volume":"64","author":"M Andrassy","year":"2022","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.avsg.2022.04.045","article-title":"Embolic Protection Devices are Not Associated with Improved Outcomes of Atherectomy for Lower Extremity Revascularization","volume":"86","author":"A Fereydooni","year":"2022","journal-title":"Ann Vasc Surg"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1093\/icvts\/ivy233","article-title":"Treatment strategies for in-stent restenosis in peripheral arterial disease: A systematic review","volume":"28","author":"S Hajibandeh","year":"2018","journal-title":"Interactive CardioVascular and Thoracic Surgery"},{"key":"ref42","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1093\/eurheartj\/ehx095","article-title":"2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: The European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS)","volume":"39","author":"V Aboyans","year":"2018","journal-title":"Eur Heart J"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"413","DOI":"10.23736\/S0021-9509.23.12607-3","article-title":"ZILVERPASS Study: ZILVER PTX Stent vs. Bypass Surgery in Femoropopliteal Lesions, 3 year results and economic analysis","volume":"64","author":"M Bosiers","year":"2023","journal-title":"J Cardiovasc Surg (Torino)"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1007\/s00270-021-02891-5","article-title":"CIRSE Standards of Practice on\u00a0Below-the-Knee Revascularisation","volume":"44","author":"S Spiliopoulos","year":"2021","journal-title":"Cardiovasc Intervent Radiol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"96","DOI":"10.4244\/EIJV11I1A17","article-title":"Intravascular ultrasound evaluation of JETSTREAM atherectomy removal of superficial calcium in peripheral arteries","volume":"11","author":"A Maehara","year":"2015","journal-title":"EuroIntervention"},{"key":"ref46","doi-asserted-by":"crossref","first-page":"99","DOI":"10.25270\/jic\/19.00418","article-title":"Intravascular Ultrasound Imaging Versus Digital Subtraction Angiography in Patients with Peripheral Vascular Disease","volume":"32","author":"G Pliagas","year":"2020","journal-title":"J Invasive Cardiol"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1177\/1526602817701720","article-title":"Lower Extremity Revascularization Using Optical Coherence Tomography-Guided Directional Atherectomy: Final Results of the EValuatIon of the PantheriS OptIcal COherence Tomography ImagiNg Atherectomy System for Use in the Peripheral Vasculature (VISION) Study","volume":"24","author":"AG Schwindt","year":"2017","journal-title":"J Endovasc Ther"},{"key":"ref48","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s42155-023-00363-0","article-title":"Safety and effectiveness of bycross rotational atherectomy and aspiration device: A prospective, multi-center pre-market approval study","volume":"6","author":"J Tessarek","year":"2023","journal-title":"CVIR Endovasc"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1016\/j.ejvs.2020.11.020","article-title":"Technical Success and Complication Rates of Retrograde Arterial Access for Endovascular Therapy for Critical Limb Ischaemia: A Systematic Review and Meta-Analysis","volume":"61","author":"S Giannopoulos","year":"2021","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/j.avsg.2023.12.105","article-title":"Retrograde Tibio-Pedal Access for Endovascular Interventions for Treating Peripheral Arterial Disease","volume":"107","author":"D McGuirl","year":"2024","journal-title":"Ann Vasc Surg"}],"container-title":["R\u00f6Fo - 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