In a new study from Johns Hopkins Medicine, researchers found that one method for restoring blood flow to clogged or completely blocked vessels is being overused or inappropriately used in the United States.
This occurs even though the procedure has not been shown to be more effective than two other less-expensive, less-risky surgical methods.
Atherectomy is one of the methods that clinicians use to remove plaque (the buildup of fat, cholesterol, calcium and other substances found in the blood) from blood vessels that have become narrowed or blocked.
Unlike balloon angioplasties and stents that push plaque into the vessel wall to open the passageway, the atherectomy cuts it out.
However, clinical studies have never demonstrated that atherectomies are any more effective in treating PAD than angioplasties, stents or a combination of the two.
In the study, the team reviewed Medicare claims data from 2019 for nearly 59,000 patients with peripheral artery disease (PAD).
The patients received elective PVI—atherectomy, angioplasty or stenting—for the first time.
The team found that atherectomies were performed more frequently on people with claudication as their reason for treatment, and people living in urban settings and in the southern United States.
Physician use of atherectomies ranged from 0% (never used) to 100% (always used), with the latter being the case for 133 clinicians—nearly 10% of the total studied.
Men were more likely to use atherectomies, as were doctors in practice for more than 20 years, cardiologists and radiologists, and those who practiced in regions with a higher median Medicare-allowed payment for PVIs per patient.
The researchers feel that these numbers—especially when there is no solid evidence that atherectomies treat PAD any more effectively than angioplasty, stents, or a combination of angioplasty and stents—suggest there is potential overuse of atherectomies in certain situations.
This poses a high health care burden and should be addressed with professional guidelines for more appropriate use of the procedure.
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The study is published in JACC: Cardiovascular Interventions. One author of the study is Caitlin Hicks, M.D.
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