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Atherectomy system confers higher primary patency in isolated popliteal lesions vs. DCB
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In a single-center study, directional atherectomy with antirestenotic therapy was linked to a higher rate of primary patency in isolated popliteal artery lesions compared with angioplasty with a drug-coated balloon.
The researchers analyzed 72 patients with isolated popliteal stenotic artery disease treated between October 2009 and December 2015. Thirty-one patients were treated with DCB angioplasty alone and 41 were treated with directional atherectomy with antirestenotic therapy. Four DCBs and four atherectomy systems were used during the study.
The primary outcome was primary patency at 12 months. Secondary outcomes included technical success, defined as < 30% residual stenosis or bailout stenting, secondary patency and freedom from clinically driven target lesion revascularization.
The technical success rates were 84% in the DCB group and 93% in the atherectomy group (P = .24), Konstantinos Stavroulakis, MD, from the department of vascular and endovascular surgery, University of Münster, Germany, and St. Franzikus-Hospital GmbH Münster, and colleagues wrote.
Primary patency at 12 months was higher in the atherectomy group (82% vs. 65%; HR = 2.64; 95% CI, 1.09-6.37), according to the researchers.
At 12 months, there were no significant differences between the groups in freedom from TLR (DCB group, 82%; atherectomy group, 94%; P = .07) or secondary patency (96% in both groups).
There was a trend toward reduced bailout stenting in the atherectomy group (5% vs. 16%; P = .13), but toward more aneurysmal degradation of the popliteal artery after atherectomy (7% vs. 0%; P = .25), the researchers wrote.
Popliteal injury occurred in two patients treated with atherectomy and none in those treated with DCB alone (P = .5), whereas distal embolization rates were 3% in the DCB group and 5% in the atherectomy group (P = .99).
“Both modalities showed excellent overall patency, offering an alternative endovascular approach in this region of high mechanical stress,” the researchers wrote. “Aneurysm formation and increased need for bailout stenting remain drawbacks of [directional atherectomy with antirestenotic therapy] and DCB angioplasty, respectively.” – by Erik Swain
Disclosure: One researcher reports serving as an advisory board member for Avinger.
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