Angioscopic Evaluation of Vascular Response After Fluoropolymer-Based Drug-Eluting Stent Implantation for Femoropopliteal Artery Lesions

Clinical Comparison of High- and Low-Dose Drug-Coated Balloons for De Novo Chronic Total Occlusive Femoropopliteal Lesions

BACKGROUND

Endovascular therapy (EVT) with a drug-coated balloon (DCB) is an established treatment for patients with atherosclerotic lesions in the femoropopliteal (FP) artery, including complex lesions. Currently, 3 types of DCBs are available, but the most effective DCB for FP chronic total occlusive (CTO) lesions is unknown.

METHODS AND RESULTS

In this retrospective, single-center study, we enrolled 539 consecutive patients (562 FP lesions) treated with EVT between January 2018 and December 2022. Of these patients, 161 with FP CTO lesions who underwent EVT with DCBs were included. Propensity-score matching was performed to compare the clinical outcomes of the high-dose (HD) and low-dose (LD) DCB groups, resulting in the analysis of 56 matched pairs. Primary patency and freedom from target lesion revascularization were significantly higher with HD-DCB than with LD-DCB (89.9% vs. 70.8%, respectively P=0.03; and 93.6% vs. 79.7%, respectively, P=0.046). Multivariate analysis showed that a larger minimum lumen area and the use of HD-DCB (vs. LD-DCB) were favorable predictors of primary patency at 1 year, while a small vessel diameter (≤4.5 mm) was an unfavorable predictor.

CONCLUSIONS

For FP CTO lesions, EVT performed with HD-DCB is superior to that with LD-DCB.

Patterns and Timings of Recurrence After Fluoropolymer-Coated Drug-Eluting Stent Use for Femoropopliteal Artery Diseases - Results of the PLANET Study

BACKGROUND

Fluoropolymer-coated drug-eluting stents (FP-DESs) are widely used to treat femoropopliteal artery (FPA) disease. However, data on the pattern and timing of recurrence after FP-DES implantation are limited. This study aimed to address this knowledge gap.

METHODS AND RESULTS

This multicenter retrospective study analyzed 439 limbs of 398 patients treated with FP-DESs for de novo FPA lesions. The outcome measures were clinical outcomes in cases of recurrence, defined as a composite of restenosis and reocclusion. The timing of recurrence was categorized into early (within 1 year of treatment) and late (after 1 year). The factors associated with recurrence were analyzed by comparing cases of early and late recurrence. The early recurrence group showed a significantly higher frequency of reocclusion, particularly stent thrombosis. In addition, in this group, patients with reocclusion tended to exhibit significantly more severe clinical symptoms than those with restenosis. Deployment of FP-DES beyond the P1 segment was independently associated with early recurrence. Chronic total occlusion was independently associated with early reocclusion. Female sex, diabetes, not using statins, and long lesions were independently associated with late recurrence. Not using statins, warfarin use, and long lesions were independent predictive factors for late reocclusion.

CONCLUSIONS

The patterns and clinical symptoms of recurrence after FP-DES implantation for FPA differed according to the timing of recurrence, as did the factors associated with recurrence.

Three-year clinical course after fluoropolymer-based drug-eluting stent implantation for femoropopliteal lesions

BACKGROUND

Although the 1-year clinical outcomes of fluoropolymer-based drug-eluting stents (FP-DES) were favorable for the treatment of real-world femoropopliteal lesions in symptomatic peripheral artery disease (PAD), their performance beyond 1 year remained unknown. The current study determined the 3-year clinical course of FP-DES implantation for real-world femoropopliteal lesions.

METHODS

This multicenter, prospective, observational study evaluated 1204 limbs (chronic limb-threatening ischemia, 34.8%; mean lesion length, 18.6 ± 9.9 cm, chronic total occlusion: 53.2%) of 1097 patients with PAD (age, 75 ± 9 years; diabetes mellitus, 60.8%) undergoing FP-DES implantation for femoropopliteal lesions. The primary outcome measure was 3-year restenosis. The secondary outcome measures included 3-year occlusive restenosis, stent thrombosis, target lesion revascularization (TLR), and aneurysmal degeneration.

RESULTS

The 3-year cumulative occurrence of restenosis was 27.3%, whereas that of occlusive restenosis, stent thrombosis, and TLR was 16.1%, 7.3%, and 19.6%, respectively. The annual occurrence of restenosis decreased by 12.0%, 9.5%, and 5.8% in the first, second, and third year, respectively (p < 0.001). Similarly, the rates of occlusive restenosis and stent thrombosis decreased (p < 0.001 and p = 0.007, respectively), whereas the rate of TLR remained unchanged for 3 years (p = 0.15). The incidence of aneurysmal degeneration at 3 years (15.7%) did not significantly differ from that at 1 and 2 years (p = 0.69 and 0.20, respectively).

CONCLUSIONS

This study highlights the favorable long-term clinical course of FP-DES in real-world practice, emphasizing the importance of monitoring for occlusive restenosis and stent thrombosis while considering the potential onset of aneurysmal degeneration.