BackTable / VI / Podcast / Episode #390
Laser Atherectomy: An Overview of the Pathfinder Registry
with Dr. Tony Das
In this episode of the BackTable Podcast, host Dr. Chris Beck discusses atherectomy, laser technologies, and their use in vessel treatment with Dr. Tony Das, an interventional cardiologist practicing in Dallas, TX and one of the founding members of the VIVA Vascular Education Course in Las Vegas.
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BackTable, LLC (Producer). (2023, December 4). Ep. 390 – Laser Atherectomy: An Overview of the Pathfinder Registry [Audio podcast]. Retrieved from https://www.backtable.com
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Podcast Contributors
Dr. Tony Das
Dr. Tony Das is an interventional cardiologist and the founder and CEO of Connected Cardiovascular Care Associates in Dallas, Texas.
Dr. Christopher Beck
Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.
Synopsis
Dr. Das shares insights on the PATHFINDER registry, which is a prospective non-randomized, multicenter study to evaluate the performance and outcome of the Auryon laser atherectomy system. Their conversation explores the role of atherectomy in reducing stent usage, decreasing embolization likelihood, enhancing thrombus removal, and uncovering lesions. Dr. Das further provides recommendations for building a successful atherectomy program, utilizing laser technologies, and the importance of having ablative technology in outpatient labs. The doctors forecast future applications for artificial intelligence and remote monitoring.
Timestamps
00:00 - Introduction
03:38 - Discussion about Connected Cardiovascular Care Associates
05:09 - Deep Dive into Atherectomy
14:06 - Understanding Laser Atherectomy
23:23 - Discussion on the PATHFINDER Study
34:52 - Advice for Building an Atherectomy Program
38:49 - Future Topics and Closing Remarks
Resources
Connected Cardiovascular Care Associates:
https://www.texasc3.com/
Pathfinder Registry Trial:
https://www.clinicaltrials.gov/study/NCT04229563#publications
Pathfinder Registry Trial Introduction:
https://evtoday.com/articles/2021-sept/introduction-to-the-pathfinder-registry-and-complex-endovascular-cases-with-the-auryon-atherectomy-system
Limb salvage following laser-assisted angioplasty for critical limb ischemia: results of the LACI multicenter trial:
https://pubmed.ncbi.nlm.nih.gov/16445313/
Randomized controlled study of excimer laser atherectomy for treatment of femoropopliteal in-stent restenosis: initial results from the EXCITE ISR trial (EXCImer Laser Randomized Controlled Study for Treatment of FemoropopliTEal In-Stent Restenosis):
https://pubmed.ncbi.nlm.nih.gov/25499305/
Cryoplasty Versus Conventional Balloon Angioplasty of the Femoropopliteal Artery in Diabetic Patients: Long-Term Results from a Prospective Randomized Single-Center Controlled Trial:
https://link.springer.com/article/10.1007/s00270-010-9915-x#Abs1
Cryoplasty for the treatment of femoropopliteal arterial disease: results of a prospective, multicenter registry:
https://pubmed.ncbi.nlm.nih.gov/16105918/
Auryon Laser from AngioDynamics:
https://www.angiodynamics.com/product/auryon/
Philips Laser System:
https://www.usa.philips.com/healthcare/product/HCIGTDPHLLSRSYSTM/laser-system-hcigtdphllsrsystm
Atherectomy plus drug-coated balloon versus drug-coated balloon only for treatment of femoropopliteal artery lesions: A systematic review and meta-analysis:
https://pubmed.ncbi.nlm.nih.gov/33478353/
Laser in Infrapopliteal and Popliteal Stenosis 2 Study (LIPS2): Long-Term Outcomes of Laser-Assisted Balloon Angioplasty Versus Balloon Angioplasty for Below Knee Peripheral Arterial Disease:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5407062/
Distal embolization during lower extremity endovascular interventions:
https://pubmed.ncbi.nlm.nih.gov/28366300/
Shockwave™ Lithoplasty in Combination With Atherectomy in Treating Severe Calcified Femoropopliteal and Iliac Artery Disease: A Single-Center Experience:
https://pubmed.ncbi.nlm.nih.gov/32563711/
Transcript Preview
[Dr. Tony Das]
That's a great question. For some people, atherectomy is a little bit more of a religion than a science. You believe in it. There may not be quite as much science as you'd like, but over time, we've continued to develop the science in this space. I think of atherectomy as an adjunctive tool. It rarely is a standalone. I think that there are lesions that really require a change in their overall response to balloon angioplasty or stenting, meaning we want to change their compliance. We use that as a broad term, but calcified lesions, we want to do something to make them less likely to dissect and have complications from balloon angioplasty. More fibrotic lesions or in-stent restenosis, we want to ablate some of that plaque. I think of it as an enabling tool. Depending on the type of lesion we're talking about, different forms of atherectomy seem to make more sense. We can talk a little bit about where we want to use certain types and where other types may be more helpful.
[Dr. Chris Beck]
For sure. One of the things I want to get at is atherectomy as an adjunct. In your practice, there's atherectomy plus. Let's exclude stenting for a second. Is it atherectomy plus POBO or atherectomy plus DCB? It depends on where? It depends on?
[Dr. Tony Das]
Yes. It depends a little bit on where, but I think that the DCB data has gotten so strong, and we finally put to bed the issue of whether there was a mortality signal for DCB. I think that's a topic that really sidetracked us for about two years. Now we understand that this is a safe technology. It's a durable technology. For me, typically, if the balloon sizes exist, especially in the above-the-knee territory, it's atherectomy plus drug-eluting balloon for the majority of the cases.
[Dr. Chris Beck]
I know that people can give whole lectures on this, but if you want to talk about the different choices that we have with atherectomy? Then, we'll zero in on where you like laser, and then for what reasons.
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