Atherectomy, scoring and drug-coated balloon angioplasty for atherosclerotic common femoral artery disease – A two center study

Summary: Background: To evaluate the ability of atherectomy combined with scoring and drug coated balloon (DCB) angioplasty for the treatment of atherosclerotic common femoral artery (CFA) disease. Patients and methods: This dual-center retrospective study analyzed data from consecutive patients who underwent atherectomy-assisted endovascular revascularization followed by scoring and DCB angioplasty and if required stent placement in the CFA. The primary endpoints included target-lesion revascularization (TLR) and improvement in clinical symptoms as measured by Rutherford categories (RC). Lesion calcification was evaluated using the Peripheral Arterial Calcification Scoring System (PACSS). Results : Of 111 patients, 64 (57.7%) had lifestyle limiting claudication, whereas 47 (42.3%) had chronic limb-threatening ischemia (CLTI). Mean age was 71.9 ± 7.8 years, 45 (40.5%) were female and 32 (28.8%) had diabetes mellitus. CFA median lesion length was 3.2 (2.4–3.7cm) and median lesion calcification by PACSS was 3.0 (3.0–3.0), whereas 13 (11.7%) were chronic total occlusions. Atherectomy was performed in 46 (41.4%) patients using the Phoenix and in 65 (58.6%) patients using the Jetstream atherectomy device with low complication rates (zero perforations and 4 (3.6%) distal embolizations). Bail-out stenting was necessary in 6 (5.4%) patients. During median follow-up of 2.0 (1.5–2.2) years, TLR was necessary in 9 (8.1%) patients, whereas RC improvement of ≥2 categories was noticed in 79 (71.2%) patients. Severe calcification PACSS four was associated with higher TLR rates (p < .001). Conclusions: Atherectomy- and scoring balloon assisted lesion preparation combined with DCB resulted in a low rate of bail-out stenting, low TLR and clinically acceptable RC improvement rates in CFAD patients. Long-term prospective trials are warranted.