Comparison of Drug-Coated Balloon Angioplasty Alone and Directional Atherectomy Combined with Drug-Coated Balloon Angioplasty in Patients with Lower Extremity Peripheral Arterial Disease with Claudication.

BACKGROUND

The objective of the study was to compare drug-coated balloon (DCB) angioplasty alone and directional atherectomy (DA) combined with DCB angioplasty in patients with lower extremity peripheral arterial disease (LE-PAD).

METHODS

Subjects treated with DCB angioplasty alone (group A) and DA combined with DCB angioplasty (group B) were enrolled in the study. A retrospective chart review was performed between the 4 years. Subjects with severe and occluded LE-PAD were included. Demographic data, atherosclerotic vessel properties, and procedural data were recorded. For both groups, success rates (technical, procedural, and clinical) were presented.

RESULTS

In total, 226 patients were evaluated. For baseline characteristics, only tobacco use and hyperlipidemia were higher in group B (P = 0.001 and P = 0.010, respectively). For the ankle-brachial index, no significant difference existed at the first, third, sixth, 12th or 24th month follow-ups. No significant difference existed for the Rutherford class at the first, third, sixth, or 12th months according to the groups. A significant difference was found at 24-month Rutherford levels. The incidence of severe claudication in group A was significantly higher than that in group B (13 [12.4%] for group A and 3 [2.8%] for group B, P = 0.035). The stenosis rate after predilatation in group B was significantly higher than that in group A (54.56 ± 5.36 for group A and 59.20 ± 6.21 for group B, P = 0.012). The distribution of full patency in the 12th month in group B was significantly higher than that in group A. The rate of 70-100% stenosis in the 12th month was significantly higher in group A than in group B. According to the groups, the distribution of the patients who were lost to follow-up and died during the follow-up and secondary results, primary patency rates, and 2-year disease-free survival rates were also similar.

CONCLUSIONS

Atherectomy combined with DCB is superior for the long-term treatment of LE-PAD.