The Relationship Between Neutrophil-to-Lymphocyte Ratio and Restenosis in Patients With Femoropopliteal Chronic Total Occlusion Treated With Drug-Coated Balloon Alone Versus Combined Atherectomy and Drug-Coated Balloon

ObjectivesTo evaluate the clinical, hematological, and anatomical outcomes of rotational atherectomy (RA) combined with drug-coated balloon (DCB) angioplasty compared to DCB alone in patients with femoropopliteal arterial disease, with particular emphasis on inflammatory markers and mid-term vessel patency.MethodsThis retrospective, single-center study included patients who underwent endovascular treatment for femoropopliteal lesions using either RA combined with DCB (RA + DCB) or DCB alone. Demographic characteristics, lesion morphology, neutrophil-to-lymphocyte ratio (NLR), and Doppler ultrasonography (DUS) findings were compared between the two groups. Primary outcomes were residual stenosis, ankle-brachial index (ABI), and mid-term vessel patency. Secondary outcomes included postprocedural NLR changes and clinical symptom evolution during follow-up.ResultsA total of 150 patients were included, with 75 treated using RA + DCB and 75 with DCB alone. There were no significant differences in baseline demographics or comorbidities between groups. The RA + DCB group demonstrated a higher prevalence of TASC A lesions and left lower extremity involvement. Postprocedural lymphocyte counts were significantly higher, and NLR values were significantly lower in the RA + DCB group. Additionally, this group exhibited lower residual stenosis rates and significantly higher patency rates at 6 and 12 months. Greater clinical improvement and a higher proportion of asymptomatic patients were observed in the RA + DCB group during follow-up.ConclusionsRA combined with DCB offers superior vascular and clinical outcomes vs DCB alone, likely due to improved lesion preparation and reduced inflammation. NLR may serve as both a prognostic biomarker and indicator of treatment efficacy in peripheral arterial interventions.