Outcomes of stented vs. non-stented femoropopliteal lesions treated with drug-coated balloon angioplasty

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J Endovasc Ther. 18 Feb 2022: 15266028221079770. doi: 10.1177/15266028221079770. Online ahead of print.

ABSTRACT

OBJECTIVE: Drug-coated balloon (DCB) angioplasty is increasingly used for the treatment of lower extremity peripheral arterial disease (PAD). However, a salvage stent may be required for suboptimal angioplasty. This study examined the outcome of femoropopliteal disease treated with DCB with/without a salvage stent.

Materials and methods: This is a monocentric retrospective study of 166 consecutive patients (DCB+stent: n=81 vs DCB: n=85) with 253 femoropopliteal lesions (DCB+stent: n=99 vs DCB: n=154) treated with DCB with/without stenting. Placement of a salvage stent was performed at the discretion of the operator for post-angioplasty dissections or any other suboptimal angiographic findings (>30% residual stenosis). A Cox regression analysis was performed to examine the results of DCB with/without stenting during the 2-year follow-up.

RESULTS: Baseline clinical characteristics were similar between the 2 groups. About half of the patients had critical limb ischemia, with most lesions localized to the superficial femoral artery. The overall mean length of the lesions was 147 ± 67 mm. The most common types of salvage stents were bare metal stents (BMS) (53.5%) followed by drug eluting stents (DES) (41.4%). Lesions requiring salvage stenting were on average longer (177 ± 67 mm vs 127 ± 59 mm; p

CONCLUSION: The drug-coated balloon with salvage stent is a viable treatment option for cases of suboptimal DCB outcomes, promising similar efficacy with DCB procedures alone. However, as patency of stents at the femoral-popliteal segment can be a challenge due to biomechanical stress on the artery, the effectiveness of the DCB+ bail-out stent needs to be further evaluated. Additionally, future studies are needed to determine which grades of post-DCB dissections should be treated and to optimize current bailout strategies.

PMID:35179065 | DO I:10.1177/15266028221079770