Top Endovascular News of 2022

Among the top peripheral endovascular intervention stories for 2022, none was bigger than the unveiling of long-awaited results from the BEST-CLI trial (BESTCLI; 49 Down), a comparison of surgery versus endovascular therapy. Paclitaxel once again remained in the headlines with 5-year data from the international IN.PACT Global Study showing no increased mortality risk with paclitaxel drug-coated balloons (DCBs; 28 Down).

Some new light also was shed on endovascular treatment of pulmonary embolism with the FLASH (43 Across) trial noting early improvements in hemodynamics and heart rate associated with a percutaneous mechanical thrombectomy device.

Finally, endovascular and surgical guidance for the diagnosis and management of aortic diseases (aorta; 58 Down) got an update in the form of new guidelines from the American College of Cardiology and the American Heart Association.

What Else?

TCTMD checked in with Sahil Parikh, MD (NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY), to talk about other interesting endovascular news that happened this year and to get a peek at what to expect in 2023.

“The SAVAL results were important because it was a below-the-knee trial and we have very few, if any, technologies for that,” he noted. Presented at the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) meeting in September, SAVAL failed to meet its primary effectiveness endpoint of superior 12-month primary patency with a DES compared with uncoated balloon in patients with symptomatic infrapopliteal artery lesions and Rutherford category 4-5 chronic limb-threatening ischemia (CLTI). Still, Parikh said the data are important since this is an area with little new innovation.

He added that paclitaxel, which has been in the news since a 2018 meta-analysis showed a signal for increased all-cause mortality at both 2 and 5 years in paclitaxel-treated PAD patients compared with those treated with uncoated devices, will probably continue to be a topic of scrutiny. This year, more long-term data from the SAFE-PAD study added reassurance that the signal is not apparent in real-world analyses, and by the end of the year, many agreed that safety concerns were waning.

Next up in 2023, Parikh said to look for data from the global LIFE-BTK trial, which will put below-the-knee interventions back in the spotlight again by comparing the everolimus-eluting Esprit BTK resorbable scaffold (Abbott) to plain balloon angioplasty in CLI patients with up to two lesions in separate infrapopliteal vessels in the same limb.

More evidence of the growing interest in limus-based devices for PAD will be seen as US-based trials of the sirolimus-coated Magic Touch DCB (Concept Medical) roll out, he added.

“There will probably be a host of other trials that are going to start in the next couple of years looking at new limus-based therapies,” Parikh concluded. However, he said he believes interest in clinical adoption of those may be somewhat “muted” by the fact that paclitaxel remains highly effective and reasonably priced, and the long-term safety concerns appear to have been sufficiently quelled.