Optimizing Excimer Laser Atherectomy Technique for Treatment of Femoropopliteal In-Stent Restenosis

Endovascular treatment of symptomatic peripheral artery disease has traditionally been performed with percutaneous transluminal angioplasty (PTA), although long-term patency in femoropopliteal arteries remains unsatisfactory. The use of bare metal stents in the femoropopliteal arteries has led to improved safety and patency compared to PTA although neointimal hyperplasia proliferation leading to in-stent restenosis (ISR) remains a common risk. Atherectomy is a promising treatment for femoropopliteal ISR because it removes plaque and neointimal hyperplasia, increasing procedural blood flow, which may improve long-term treatment outcomes. FDA approval was recently received for atherectomy with the Turbo-Tandem excimer laser catheter system for treatment of femoropopliteal ISR (the Spectranetics Corporation). The purpose of this paper is to describe the procedural technique of excimer laser atherectomy within ISR and to highlight the clinical utility of this technology in challenging case examples. VASCULAR DISEASE MANAGEMENT 2016;13(1):E17-E30