Intravascular Ultrasound Predictors of 12-Month Patency Loss Following Drug-Coated Balloon Angioplasty for the Femoropopliteal Artery

Jaeoh Lee; Ji Yong Jang; Chul-Min Ahn; Seung-Jun Lee; Sang-Hyup Lee; Yong-Joon Lee; Sung-Jin Hong; Jung-Sun Kim; Byeong-Keuk Kim; Myeong-Ki Hong; Yangsoo Jang; Tae-Hoon Kim; Ha-Wook Park; Jae-Hwan Lee; Jae-Hyeong Park; Su Hong Kim; Eui Im; Sang-Ho Park; Donghoon Choi; Young-Guk Ko; IVUS-DCB Investigators

doi:Intravascular ultrasound (IVUS) has been shown to improve outcomes of drug-coated balloon (DCB) angioplasty for treatment of femoropopliteal artery (FPA) disease. However, the optimal IVUS criteria for achieving improved outcomes of DCB angioplasty for FPA disease remain uncertain. The study aimed to identify IVUS predictors for loss of patency at 12 months after DCB angioplasty for FPA disease. After excluding one patient due to insufficient IVUS imaging data, 98 patients in the IVUS-guidance group of the IVUS-DCB trial were included in the analysis. IVUS parameters predicting loss of patency at 12 months and their optimal cut-off values were investigated. Among the 98 patients who underwent IVUS-guided FPA intervention, 16 patients (16.3%) lost primary patency within 12 months. End-stage renal disease on hemodialysis and, bailout stenting, postprocedural dissection length >50% were independent procedural predictors for 12-month patency loss. Receiver operating characteristic (ROC) curve demonstrated that postprocedural minimal lumen area (MLA) ≥ 11.6 mm2 (area under the ROC curve: 0.685, 95% CI: 0.513 to 0.857) as the optimal cut-off value for sustained primary patency. In survival analysis, patients with MLA ≥ 11.6 mm2 had a hazard ratio of 0.27 (95% CI: 0.09 to 0.80, p-value = 0.019, risk difference: 19.8) for lower risk of patency loss. A postprocedural MLA ≥11.6 mm2 was an independent IVUS predictor for sustained primary patency after DCB angioplasty in patients with FPA disease. Our findings suggest that lesion optimization and achieving sufficient lumen area under IVUS guidance during DCB angioplasty are crucial for maintaining target vessel patency.

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Intravascular Ultrasound Predictors of 12-Month Patency Loss Following Drug-Coated Balloon Angioplasty for the Femoropopliteal Artery

Authors: Jaeoh Lee ; Ji Yong Jang ; Chul-Min Ahn ; Seung-Jun Lee ; Sang-Hyup Lee ; Yong-Joon Lee ; Sung-Jin Hong ; Jung-Sun Kim ; Byeong-Keuk Kim ; Myeong-Ki Hong ; Yangsoo Jang ; Tae-Hoon Kim ; Ha-Wook Park ; Jae-Hwan Lee ; Jae-Hyeong Park ; Su Hong Kim ; Eui Im ; Sang-Ho Park ; Donghoon Choi ; Young-Guk Ko ; IVUS-DCB Investigators

Citation: AMERICAN JOURNAL OF CARDIOLOGY, Vol.246 : 58-64, 2025-07

Journal Title: AMERICAN JOURNAL OF CARDIOLOGY

ISSN: 0002-9149

Issue Date: 2025-07

MeSH: 1

Keywords: Aged ; Angioplasty, Balloon* / methods ; Coated Materials, Biocompatible* ; Female ; Femoral Artery* / diagnostic imaging ; Femoral Artery* / surgery ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Peripheral Arterial Disease* / diagnostic imaging ; Peripheral Arterial Disease* / surgery ; Peripheral Arterial Disease* / therapy ; Popliteal Artery* / diagnostic imaging ; Popliteal Artery* / surgery ; ROC Curve ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Ultrasonography, Interventional* / methods ; Vascular Patency* / physiology

Abstract: angioplasty ; drug-coated balloon ; femoropopliteal artery ; intravascular ultrasound ; peripheral artery disease

Article Number: 10.1016/j.amjcard.2025.03.018

DOI: Intravascular ultrasound (IVUS) has been shown to improve outcomes of drug-coated balloon (DCB) angioplasty for treatment of femoropopliteal artery (FPA) disease. However, the optimal IVUS criteria for achieving improved outcomes of DCB angioplasty for FPA disease remain uncertain. The study aimed to identify IVUS predictors for loss of patency at 12 months after DCB angioplasty for FPA disease. After excluding one patient due to insufficient IVUS imaging data, 98 patients in the IVUS-guidance group of the IVUS-DCB trial were included in the analysis. IVUS parameters predicting loss of patency at 12 months and their optimal cut-off values were investigated. Among the 98 patients who underwent IVUS-guided FPA intervention, 16 patients (16.3%) lost primary patency within 12 months. End-stage renal disease on hemodialysis and, bailout stenting, postprocedural dissection length >50% were independent procedural predictors for 12-month patency loss. Receiver operating characteristic (ROC) curve demonstrated that postprocedural minimal lumen area (MLA) ≥ 11.6 mm2 (area under the ROC curve: 0.685, 95% CI: 0.513 to 0.857) as the optimal cut-off value for sustained primary patency. In survival analysis, patients with MLA ≥ 11.6 mm2 had a hazard ratio of 0.27 (95% CI: 0.09 to 0.80, p-value = 0.019, risk difference: 19.8) for lower risk of patency loss. A postprocedural MLA ≥11.6 mm2 was an independent IVUS predictor for sustained primary patency after DCB angioplasty in patients with FPA disease. Our findings suggest that lesion optimization and achieving sufficient lumen area under IVUS guidance during DCB angioplasty are crucial for maintaining target vessel patency.

Appears in Collections:: 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers

URI: https://ir.ymlib.yonsei.ac.kr/handle/22282913/207533

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