ReviewReviews in cardiovascular medicine2026
The Role of Atherectomy in Lesion Preparation for Peripheral Artery Disease: Evolution of Technologies, Available Devices, and Contemporary Evidence.
Review in Reviews in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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0 citing papers in PubMed.
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Authors and funding
2 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Atherectomy has become an established tool for lesion preparation in the endovascular treatment of peripheral artery disease (PAD), particularly for complex and heavily calcified lesions. Despite the widespread clinical use of atherectomy, the long-term benefits of this tool remain controversial, and the available evidence is heterogeneous. This review aimed to provide a clinically oriented, expert-driven narrative evaluation of peripheral atherectomy, including the historical evolution, currently available technologies, and the contemporary clinical role of the procedure, while integrating randomized and real-world evidence to support rational patient and lesion selection. A narrative literature review was conducted based on continuous expert monitoring since 2021 and targeted PubMed searches using combinations of the terms "peripheral artery disease", "atherectomy", "critical limb ischemia", and "intermittent claudication". Randomized controlled trials, meta-analyses, major registries, and high-quality observational studies were identified, selected based on clinical relevance and methodological quality, and synthesized accordingly. Randomized trials have consistently shown that atherectomy does not provide superior long-term patency or limb salvage compared with balloon angioplasty, stenting, or drug-coated balloons (DCB). However, atherectomy has demonstrated reproducible procedural advantages across multiple studies, including greater luminal gain, fewer dissections, and less need for bailout stenting. Observational and registry data further suggest potential benefits in selected scenarios, particularly for heavily calcified lesions, long-segment occlusions, in-stent restenosis (ISR), and anatomically challenging mobile segments. Current evidence does not support the routine use of atherectomy in PAD. Nevertheless, when applied selectively in appropriately chosen patients and lesions, atherectomy represents a valuable strategy for vessel preparation. The responsible use of atherectomy requires careful integration of the available evidence with operator expertise, awareness of alternative technologies, and consideration of procedural risks and reimbursement issues.
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