Cardiology and Beyond: Bishnu's Personal Blog: Advances in Endovascular (PAD) Treatments and Devices in 2024

BASIL-3 Trial: DES/DCB Versus Plain Balloon Angioplasty

The BASIL-3 trial found no significant improvement in amputation-free survival for patients with chronic limb-threatening ischemia (CLTI) treated with drug-eluting stents (DES) or drug-coated balloons (DCB) compared to plain balloon angioplasty.
Experts debated the trial's endpoints, noting that COVID-related deaths may have diluted the mortality outcomes and that the study was likely underpowered.

The FDA approved the everolimus-eluting Esprit BTK scaffold (Abbott Vascular) based on the LIFE-BTK study, which showed its safety and efficacy compared to angioplasty alone.
The 2-year data revealed fewer reinterventions in scaffold-treated patients, and researchers highlighted its potential to prevent biologic restenosis.
Other BTK innovations included the Shockwave E8 peripheral intravascular lithotripsy (IVL) catheter, designed for challenging lesions, and the Bare Temporary Spur system (Reflow Medical), which mimics stenting without long-term implant risks.

The DETOUR 2 trial demonstrated sustained patency at 3 years for percutaneous transmural arterial bypass, an endovascular technique for complex superficial femoropopliteal lesions that eliminates the need for open surgical cutdowns.
The technique was noted as a valuable option for patients who failed standard interventions, with no reports of late venous issues or deep vein thrombosis (DVT) complications.

The SIRONA trial compared paclitaxel-based DCBs and sirolimus-based DCBs, finding no differences in primary patency or major adverse outcomes at 1 year.
The study, which will follow patients for 5 years, aims to clarify the long-term safety and efficacy of sirolimus DCBs for below-the-knee lesions.

The Javelin device (Shockwave Medical), a forward-facing IVL catheter, showed high success rates in crossing heavily calcified peripheral lesions, with pooled data reporting 93% success in achieving full lesion crossing.

The PEERLESS trial demonstrated the superiority of large-bore mechanical thrombectomy with the FlowTriever system (Inari Medical) over catheter-directed thrombolysis for intermediate-risk pulmonary embolism.
Patients treated with thrombectomy had fewer clinical deteriorations, shorter hospital stays, lower 30-day readmission rates, and better early recovery outcomes at 24 hours.

Updated PAD guidelines emphasized rigorous medical therapy, collaborative vascular care, and the importance of foot care across the spectrum of PAD and CLTI.

The American Heart Association issued a scientific statement on the benefits of radial access in peripheral vascular interventions while acknowledging barriers to its widespread adoption.

The SAFE-IVC study found that only 15% of Medicare patients with implanted inferior vena cava filters had them removed in a timely manner, a statistic described as “inexplicably and unacceptably low.”

Following Medicare’s expanded coverage for CAS and trans carotid artery revascularization, debates arose over patient safeguards and operator training to address skill gaps.
Experts stressed the need for professional societies to close educational gaps among younger operators less experienced in carotid interventions.

New devices and therapies for BTK lesions have renewed optimism, particularly in addressing nonhealing wounds and complex cases.
Researchers anticipate more real-world data on the effectiveness of devices like the Esprit BTK scaffold and innovations such as the Javelin device and Shockwave E8 IVL catheter in treating difficult peripheral artery cases.

Cardiology and Beyond: Bishnu's Personal Blog