Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Clinical Outcomes of Atherectomy Plus Drug-coated Balloon Versus Drug-coated Balloon Alone in the Treatment of Femoropopliteal Artery Disease

  • Jung-Joon Cha (Division of Cardiology, Korea University Anam Hospital, Korea University College of Medicine) ;
  • Jae-Hwan Lee (Division of Cardiology, Chungnam National University Sejong Hospital) ;
  • Young-Guk Ko (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Jae-Hyung Roh (Division of Cardiology, Chungnam National University Sejong Hospital) ;
  • Yong-Hoon Yoon (Division of Cardiology, Chungnam National University Sejong Hospital) ;
  • Yong-Joon Lee (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Seung-Jun Lee (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Sung-Jin Hong (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Chul-Min Ahn (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Jung-Sun Kim (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Byeong-Keuk Kim (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Donghoon Choi (Division of Cardiology, Yongin Severance Hospital, Yonsei University College of Medicine) ;
  • Myeong-Ki Hong (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Yangsoo Jang (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine)
  • Received : 2021.07.16
  • Accepted : 2021.09.29
  • Published : 2022.02.01
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Abstract

Background and Objectives: Atherectomy as a pretreatment has the potential to improve the outcomes of drug-coated balloon (DCB) treatment by reducing and modifying atherosclerotic plaques. The present study investigated the outcomes of atherectomy plus DCB (A+DCB) compared with DCB alone for the treatment of femoropopliteal artery disease. Methods: A total of 311 patients (348 limbs) underwent endovascular therapy using DCB for native femoropopliteal artery lesions at two endovascular centers. Of these, 82 limbs were treated with A+DCB and 266 limbs with DCB alone. After propensity score matching based on clinical and lesion characteristics, a total of 82 pairs was compared for immediate and mid-term outcomes. Results: For the matched study groups, the lesion length was 172.7±111.2 mm, and severe calcification was observed in 43.3%. The technical success rate was higher in the A+DCB group than in the DCB group (80.5% vs. 62.2%, p=0.015). However, the A+DCB group showed more procedure-related minor complications (37.0% vs. 13.4%, p=0.047). At 2-year follow-up, primary clinical patency (73.8% vs. 82.6%, p=0.158) and the target lesion revascularization (TLR)-free survival (84.3% vs. 88.2%, p=0.261) did not differ between the two groups. In Cox proportional hazard analysis, atherectomy showed no significant impact on the outcome of DCB treatments. Conclusions: The pretreatment with atherectomy improved technical success of DCB treatment; however, it was associated with increased minor complications. In this study, A+DCB showed no clinical benefit in terms of TLR-free survival or clinical patency compared with DCB treatment alone.

Keywords

Acknowledgement

This research was supported by grants from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) and a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (HC20C0081), the Korea Medical Device Development Fund funded by the Korean government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (202011B29-03, 202011D12-02) and the Cardiovascular Research Center (Seoul, Korea).

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