The Limb Salvage PAteNcy Rate After Directional Atherectomy Combined With Drug-Coated Balloon Angioplasty in Lower Extremities: PANDA Trial

The application of THPRS demonstrates good safety and efficacy, and may offer a viable option advantages in long and calcified lesions.Clinical ImpactThe PANDA Trial demonstrates that directional atherectomy (TurboHawk) combined with drug-coated balloon (DCB) angioplasty achieves high 1- and 2-year patency rates (88.2% and 74.8%, respectively) in femoropopliteal lesions, with low bailout stenting (3.7%) and TLR rates (17.1%). This approach may offer distinct advantages for long (>25 cm) and calcified lesions, where traditional DCB angioplasty alone faces mechanical limitations. For clinicians, this supports atherectomy as an adjunct to DCB in complex PAD, potentially reducing restenosis and stent dependency. The innovation lies in plaque debulking before DCB, optimizing drug delivery and vessel compliance. These findings advocate for broader adoption of combined atherectomy-DCB strategies in challenging lower extremity revascularizations.