Percutaneous Atherectomy Versus Balloon Angioplasty/Stenting in the Treatment of Femoropopliteal Arterial Occlusive Disease

TL;DR

This study compares atherectomy and balloon angioplasty/stenting for treating leg artery blockages and finds that atherectomy reduces lesion occlusion without improving patency.

Contribution

A nationwide registry analysis comparing percutaneous atherectomy and balloon angioplasty/stenting for femoropopliteal disease.

Findings

Atherectomy did not improve 1-year primary patency compared to balloon angioplasty/stenting.

Atherectomy significantly reduced the risk of target lesion occlusion during follow-up.

Mortality rates were similar between the two treatment groups.

Abstract

Objectives: Atherectomy use for the treatment of femoropopliteal lesions has significantly increased. This study aimed to assess the clinical benefits of percutaneous atherectomy (PA) over balloon angioplasty and/or stenting (PTA ± stent) for femoropopliteal arterial disease using a nationwide prospective multicenter registry. Methods: Using data from the Damoeum registry of the Korean Society for Vascular Surgery, we identified patients with revascularization due to lower-extremity arterial disease. After excluding patients who underwent open and hybrid revascularization, we compared the clinical outcomes of the patients in the PA group versus the PTA ± stent group. We investigated the target lesion patency and functional and safety outcomes during the follow-up. Results: A total of 424 patients were included in the final analysis: 90 in the PA group and 334 in the PTA ± stent group. There were 344 men and 79 women (mean age: 71.1 years). The preprocedural ankle–brachial index (ABI) was significantly increased in both groups (p = 0.015). When we compared 90 patients of the PA group and 270 patients of the matched PTA ± stent cohort (1:3 propensity-matched cohort), the overall 1-year primary patency rate was not significantly different (83.8% vs. 80.0%; p = 0.895). However, the PA group showed a significantly lower risk of occlusion compared with the PTA ± stent group during the follow-up (adjusted HR: 0.01; p < 0.001). Overall mortality was similar in the two groups (p = 0.695). Conclusions: The use of atherectomy was not associated with improvement in target lesion patency. However, the use of atherectomy devices demonstrated a significant reduction in target lesion occlusion during the follow-up.

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