Atherectomy Is Not Associated With Improved Limb-Based Outcomes Among Patients in the BEST-CLI Trial Undergoing Endovascular Revascularization

Hicks, CW; Farber, A; Doros, G; Kinlay, S; Powell, RJ; Strong, MB; Rosenfield, K; Aridi, H; Motaganahalli, R; Barleben, A; Siracuse, JJ; Azene, E; Malas, M; Conte, MS; Zayed, M; Menard, MT

doi:10.1016/j.jcin.2025.10.065

Aortic & peripheral vascular disease

Atherectomy Is Not Associated With Improved Limb-Based Outcomes Among Patients in the BEST-CLI Trial Undergoing Endovascular Revascularization

JACC Cardiovasc IntervPublished 12 Jan 2026Secondary analysis of the BEST-CLI randomised trial

Primary result · MALEResultAdjusted hazard ratio 1.30 95% CI 0.92–1.84

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Authors' conclusion

Atherectomy was associated with similar or slightly worse limb-based outcomes among patients undergoing endovascular revascularization for CLTI compared with other available endovascular technologies.

Study context

Population: Patients with chronic limb-threatening ischemia (CLTI) treated with endovascular revascularization in the BEST-CLI trial
Participants: 923 patients

Comparison: Endovascular revascularization with vs without atherectomy
Atherectomyn = 132
Primary endpoint: Major adverse limb events (MALE):
Major reintervention
Above-ankle amputation in the index limb

Methodological detailsprospective

Prospective

Primary result

MALE

Adjusted hazard ratio

1.30

95% CI 0.92–1.84

Atherectomy vs No atherectomy

aHR 1.30 (95% CI 0.92–1.84)

As reported in the abstract

Secondary outcomes

Outcome	← Lower with atherectomy ←→ Higher with atherectomy →	Estimate	P value
Major reintervention	0.512	aHR for major reintervention 1.07 (95% CI 0.67–1.73)
Above-ankle amputation	0.512	aHR for above-ankle amputation 1.32 (95% CI 0.81–2.15)
All-cause death	0.512	aHR for all-cause death 1.06 (95% CI 0.75–1.49)
Major adverse limb events in patients with technical success (sensitivity analysis)P is unadjusted log-rank; higher MALE with atherectomy	0.512	aHR for MALE (major reintervention or above-ankle amputation) 1.51 (95% CI 1.03–2.22)	P = 0.02
	0.512Ratio (log scale)

Major adverse limb events in patients with technical success (sensitivity analysis): sensitivity analysis limited to patients with technical success

Original publication

Atherectomy Is Not Associated With Improved Limb-Based Outcomes Among Patients in the BEST-CLI Trial Undergoing Endovascular Revascularization. JACC Cardiovasc Interv. Published 12 January 2026. doi:10.1016/j.jcin.2025.10.065

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Summarised from the published abstract; every number is checked against it