Atherectomy, scoring and drug-coated balloon angioplasty for atherosclerotic common femoral artery disease - A two center study.

Background

To evaluate the ability of atherectomy combined with scoring and drug coated balloon (DCB) angioplasty for the treatment of atherosclerotic common femoral artery (CFA) disease. Patients and methods: This dual-center retrospective study analyzed data from consecutive patients who underwent atherectomy-assisted endovascular revascularization followed by scoring and DCB angioplasty and if required stent placement in the CFA. The primary endpoints included target-lesion revascularization (TLR) and improvement in clinical symptoms as measured by Rutherford categories (RC). Lesion calcification was evaluated using the Peripheral Arterial Calcification Scoring System (PACSS).

Results

Of 111 patients, 64 (57.7%) had lifestyle limiting claudication, whereas 47 (42.3%) had chronic limb-threatening ischemia (CLTI). Mean age was 71.9 ± 7.8 years, 45 (40.5%) were female and 32 (28.8%) had diabetes mellitus. CFA median lesion length was 3.2 (2.4-3.7cm) and median lesion calcification by PACSS was 3.0 (3.0-3.0), whereas 13 (11.7%) were chronic total occlusions. Atherectomy was performed in 46 (41.4%) patients using the Phoenix and in 65 (58.6%) patients using the Jetstream atherectomy device with low complication rates (zero perforations and 4 (3.6%) distal embolizations). Bail-out stenting was necessary in 6 (5.4%) patients. During median follow-up of 2.0 (1.5-2.2) years, TLR was necessary in 9 (8.1%) patients, whereas RC improvement of ≥2 categories was noticed in 79 (71.2%) patients. Severe calcification PACSS four was associated with higher TLR rates (p < .001).

Conclusions

Atherectomy- and scoring balloon assisted lesion preparation combined with DCB resulted in a low rate of bail-out stenting, low TLR and clinically acceptable RC improvement rates in CFAD patients. Long-term prospective trials are warranted.