The impact of diabetes on rotational atherectomy and drug-coated balloon outcomes in lower extremity chronic total occlusions

Aims: This study aimed to evaluate the effect of combining rotational atherectomy (RA) and drug-coated balloon (DCB) angioplasty on clinical outcomes in diabetic (DMG) and non-diabetic (NDMG) patients with chronic total occlusions (CTOs) in the lower extremity arteries (LEAs). Methods: A total of 151 patients treated between 2018 and 2022 were retrospectively analyzed. Patients were categorized as DMG (n=77) and NDMG (n=74). Outcomes such as technical success, vessel patency, re-occlusion, and ankle-brachial index (ABI) were compared between the groups. Results: Technical success was achieved in all patients, with a stent usage rate below 8%. At 12 months, re-occlusion occurred in 13.0% of DMG and 5.4% of NDMG patients. Both groups showed a significant increase in ABI: from 0.60 to 1.10 in DMG and from 0.60 to 1.20 in NDMG. The 12-month re-occlusion-free survival rate was 87.0% in DMG and 94.6% in NDMG. Conclusion: RA combined with DCB angioplasty appears to be a safe and effective treatment strategy for CTOs in LEAs. The approach offers high technical success and favorable mid-term outcomes in both diabetic and non-diabetic patients, supporting its use in high-risk populations.