Atherectomy-assisted treatment or balloon angioplasty for atherosclerotic common femoral artery disease?

Background: To compare atherectomy-assisted endovascular revascularization with balloon angioplasty for the treatment of common femoral artery disease (CFAD). Materials and methods: In a multi-centre retrospective research collaborative, data from consecutive patients who underwent endovascular revascularization of the groin were analysed. Primary endpoints were clinically driven target-lesion-revascularization (CD-TLR) and improvement of clinical symptoms by Rutherford categories (RC). Kaplan-Mayer analyses were used to evaluate these endpoints over time in patients undergoing atherectomy-assisted versus conventional endovascular treatment. In addition, retrospective case-control matching was performed, considering patient and lesion specific characteristics. Lesion calcification was assessed using the PACSS scoring system. Results: Of 225 patients, 179 (79.6%) underwent atherectomy-assisted treatment, whereas 46 (20.4%) underwent balloon angioplasty. Mean age was 72.0 (66.0-79.0) yrs, 139 patients (61.8%) had intermittent claudication and 84 (37.3%) had chronic limb-threatening ischemia (CLTI). Involvement of the deep femoral artery femoral was present in 137 (60.9%) cases, whereas lesion calcification was moderate to severe (PACSS 2-4) in most cases (88%). Atherectomy had low complication rates (perforation in one (0.6%) patient and distal embolization requiring re-intervention in 2 (0.9%) patients) and lower rates of bail-out stenting compared to angioplasty (5.1% versus 36.7%, p<.0001). No perforation or distal embolization was observed in the angioplasty group. After matching for patient and lesion characteristics CD-TLR (HR=4.0, 95%CI=1.0-15.0, p<.05) and RC improvement rates both favoured atherectomy (93.5% versus 73.1%, p<.05). Conclusions: Atherectomy-assisted endovascular revascularization of CFAD seems to be associated with lower stent placement and re-intervention rates compared to balloon angioplasty. Future prospective trials with longer follow-up duration are now warranted.