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Drug Eluting Stent vs. Drug Coated Balloon for Native Femoropopliteal Artery Disease: A Two Centre Experience

Authors
 Yong-Joon Lee  ;  Hyungdon Kook  ;  Young-Guk Ko  ;  Cheol Woong Yu  ;  Hyung Joon Joo  ;  Chul-Min Ahn  ;  Donghoon Choi 
Citation
 EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol.61(2) : 287-295, 2021-02 
Journal Title
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
ISSN
 1078-5884 
Issue Date
2021-02
MeSH
Adult ; Aged ; Aged, 80 and over ; Angioplasty, Balloon / instrumentation* ; Angioplasty, Balloon / methods ; Drug-Eluting Stents* ; Endovascular Procedures / instrumentation* ; Endovascular Procedures / methods ; Female ; Femoral Artery / surgery* ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Middle Aged ; Peripheral Arterial Disease / surgery* ; Popliteal Artery / surgery* ; Propensity Score ; Proportional Hazards Models ; Prospective Studies ; Retrospective Studies ; Treatment Outcome
Keywords
Drug-coated balloon ; Drug-eluting stent ; Endovascular ; Femoropopliteal artery disease
Abstract
Objective: There have been limited clinical trials comparing drug eluting stents (DESs) and drug coated balloons (DCBs) in the treatment of femoropopliteal artery disease. This two centre retrospective and prospective cohort study sought to compare DES with DCB for the treatment of native femoropopliteal artery disease.

Methods: A total of 288 limbs (242 patients) with native femoropopliteal artery disease were treated with DESs (Zilver PTX; 102 limbs) or DCBs (IN.PACT Admiral; 186 limbs) in two Korean endovascular centres between 19 January 2013 and 5 May 2018 and followed for a median duration of 19.6 months. The primary endpoint was primary clinical patency. Propensity score matching (PSM, 162 limbs) and inverse probability weighted (IPW) adjustment were performed to adjust for confounding baseline characteristics.

Results: The DCB group had fewer lesions with Trans-Atlantic Inter-Society Consensus (TASC) II type C/D (55.9% vs. 70.6%, p = .021) or total occlusions (43.5% vs. 77.5%, p < .001) and showed shorter lesion lengths (164.2 ± 105.4 mm vs. 194.8 ± 86.8 mm, p = .009) than the DES group. After PSM, baseline clinical and lesion characteristics of the two groups were comparable except for larger reference vessel diameter in the DES group (5.4 ± 0.6 vs. 5.1 ± 0.7, p = .025). Adjunctive atherectomy was performed in 32.1% of the DCB group and in 2.5% of the DES group (p < .001). The provisional stenting was required in 14.8% of the DCB group. At two year follow up, the DCB group showed higher primary clinical patency (74.6% vs. 56.7%, hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.27-0.96, p = .032) and freedom from target lesion revascularisation (85.9% vs. 71.3%, HR 0.39, 95% CI 0.17-0.89, p = .021) than the DES group. Survival from all cause death did not differ between groups (87.6% vs. 92.1%, HR 1.85, 95% CI 0.62-5.52, p = .26).

Conclusion: In this two centre cohort, DCBs with selective use of adjunctive atherectomy achieved more favourable outcomes than DESs for native femoropopliteal artery disease.
Full Text
https://www.sciencedirect.com/science/article/pii/S107858842030914X
DOI
10.1016/j.ejvs.2020.10.008
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Ahn, Chul-Min(안철민) ORCID logo https://orcid.org/0000-0002-7071-4370
Lee, Yong Joon(이용준)
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/184243
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