Endovascular Atherectomy in Peripheral Artery Disease, Coronary Artery Disease, and Non-Atherosclerotic Vascular Conditions: Scoping Review with ☸SAIMSARA

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To comprehensively map the clinical evidence on endovascular atherectomy across peripheral artery disease, coronary artery disease, and non-atherosclerotic vascular conditions, synthesizing data on technical success, clinical outcomes, reintervention, and safety across different devices, anatomical segments, and clinical indications, while also characterizing practice patterns and health-system implications. The review uses 172 references and builds its evidence map from 302 original studies with 1732527 total participants/sample observations (topic-deduplicated ΣN). This scoping review indicates that endovascular atherectomy reliably achieves high acute technical success in complex, calcified lesions but does not consistently translate into superior long-term outcomes compared with angioplasty or stenting, with adjusted safety endpoints showing no significant difference (aHR 0.99). The evidence supports a role for atherectomy chiefly as a lesion-preparation adjunct to drug-coated balloon therapy rather than a standalone strategy, while highlighting a replicated trade-off of increased reintervention (aHR 1.21) and elevated distal embolization. A more favorable signal emerges in isolated popliteal disease, where atherectomy was associated with higher freedom from major amputation. These patterns, alongside utilization shifts toward office-based settings driven by non-clinical factors, warrant scrutiny of appropriateness. Randomized trials with standardized endpoints are needed to clarify where selective atherectomy genuinely improves limb outcomes.