Comparison of atherectomy and drug-coated balloon in critical femoropopliteal lesions mid-term results

Aim: Peripheral artery disease (PAD) restricts blood flow to the lower limbs, causing pain, reduced mobility, and critical limb ischemia, leading to severe complications. While atherectomy and drug-coated balloon (DCB) angioplasty are effective revascularization methods, restenosis remains challenging, especially in calcified lesions. This study aims to compare mid-term outcomes, including primary patency, complication rates, and re-intervention needs, between atherectomy combined with DCB angioplasty and DCB-only treatment in patients with femoropopliteal artery disease. Material and Methods: We conducted a retrospective review of 144 PAD patients treated between March 2020 and March 2022. Patients were divided into two groups: 66 received atherectomy plus DCB, while 78 underwent DCB-only angioplasty. Baseline characteristics, lesion parameters, and clinical outcomes, including primary patency and complication rates, were assessed at 6, 12, and 24 months post-procedure using color Doppler ultrasonography (CDUS). Results: At 6 months, patency rates were similar across both groups, but the atherectomy + DCB group showed significantly higher patency at 12 months (p=0.045) and 24 months (p=0.04). Complications, including distal embolism, arterial dissection, and pseudoaneurysm, were comparable between groups. The atherectomy + DCB group also had lower target lesion revascularization rates, suggesting reduced need for re-interventions. Conclusion: Atherectomy combined with DCB angioplasty yields superior mid-term patency compared to DCB alone, especially in patients with calcified lesions. This approach optimizes drug delivery and reduces re-intervention needs, offering a viable option for complex femoropopliteal PAD. Future randomized trials are recommended to confirm these findings and refine patient-specific treatment strategies. [Turk J Vasc Surg 2025; 34(1.000): 3-9]