Korean Circ J.  2022 Feb;52(2):123-133. 10.4070/kcj.2021.0246.

Clinical Outcomes of Atherectomy Plus Drug-coated Balloon Versus Drugcoated Balloon Alone in the Treatment of Femoropopliteal Artery Disease

• Cha JJ
• Lee JH
• Ko YG
• Roh JH
• Yoon YH
• Lee YJ
• Lee SJ
• Hong SJ
• Ahn CM
• Kim JS
• Kim BK
• Choi D
• Hong MK
• Jang Y

• KMID: 2525451
• DOI: http://doi.org/10.4070/kcj.2021.0246

Abstract

Background and Objectives
Atherectomy as a pretreatment has the potential to improve the outcomes of drug-coated balloon (DCB) treatment by reducing and modifying atherosclerotic plaques. The present study investigated the outcomes of atherectomy plus DCB (A+DCB) compared with DCB alone for the treatment of femoropopliteal artery disease.
Methods
A total of 311 patients (348 limbs) underwent endovascular therapy using DCB for native femoropopliteal artery lesions at two endovascular centers. Of these, 82 limbs were treated with A+DCB and 266 limbs with DCB alone. After propensity score matching based on clinical and lesion characteristics, a total of 82 pairs was compared for immediate and mid-term outcomes.
Results
For the matched study groups, the lesion length was 172.7±111.2 mm, and severe calcification was observed in 43.3%. The technical success rate was higher in the A+DCB group than in the DCB group (80.5% vs. 62.2%, p=0.015). However, the A+DCB group showed more procedure-related minor complications (37.0% vs. 13.4%, p=0.047). At 2-year follow-up, primary clinical patency (73.8% vs. 82.6%, p=0.158) and the target lesion revascularization (TLR)-free survival (84.3% vs. 88.2%, p=0.261) did not differ between the two groups. In Cox proportional hazard analysis, atherectomy showed no significant impact on the outcome of DCB treatments.
Conclusions
The pretreatment with atherectomy improved technical success of DCB treatment; however, it was associated with increased minor complications. In this study, A+DCB showed no clinical benefit in terms of TLR-free survival or clinical patency compared with DCB treatment alone.

Keyword

Femoral artery; Popliteal artery; Atherectomy; Paclitaxel; Balloon angioplasty

Figure

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  Figure 1 Kaplan-Meier survival analysis for primary clinical patency; unmatched study population (A) and propensity score-matched study population (B).A+DCB = atherectomy plus drug-coated balloon; DCB = drug-coated balloon.

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  Figure 2 Kaplan-Meier survival analysis for target lesion revascularization-free survival; unmatched study population (A) and propensity score-matched study population (B).A+DCB = atherectomy plus drug-coated balloon; DCB = drug-coated balloon; TLR = target lesion revascularization.

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