title: Drug-coated balloons vs. drug-eluting stents for treatment of long femoropopliteal lesions.
abstract: OBJECTIVE
  To compare the performance of drug-coated balloons (DCB) and drug-eluting stents (DES) in long femoropopliteal lesions.
  
  
  METHODS
  A retrospective dual center study included 228 patients (139 men; median age 69 years) with femoropopliteal lesions ≥10 cm suffering from peripheral artery disease (Rutherford categories 1-5) treated either with DCB or DES. Propensity score stratification was used to minimize bias. The 131 DCB patients (77 men; mean age 68.9±10.5 years) had a mean lesion length of 194.4±86.3 mm (range 100-450), while the 97 DES patients (62 men; mean age 68.2±8.0 years) had lesions averaging 195.0±64.5 mm (range 100-350) in length. Restenotic lesions were treated in 68 (51.9%) DCB patients and 43 (44.3%) DES patients; over half the lesions in both groups were total occlusions [DCB: 69 (52.7%), DES: 61 (62.9%)]. Outcome measures were patency (peak systolic velocity ratio <2.4), clinically driven target lesion revascularization (TLR), event-free survival, and freedom from worsening of Rutherford classification by ≥2 categories.
  
  
  RESULTS
  In the DCB cohort, provisional stent placement was performed in 24 (18.3%) lesions for refractory stenosis (5, 3.8%), flow-limiting dissection (13, 9.9%), and other reasons (6, 4.6%). There was no procedure-related mortality in either cohort. The binary restenosis rates were 23.9% (26/109) and 30.4% (24/79, p=0.319) in the DCB and DES cohorts, respectively, and clinically driven TLR rates were 15.6% (17/109) vs. 19.0% (15/79, p=0.543), respectively. Estimates for freedom from clinically driven TLR and event-free survival were not different between the study cohorts nor were outcomes regarding the ankle-brachial index and Rutherford category.
  
  
  CONCLUSIONS
  DCB and DES perform equally well in the endovascular treatment of femoropopliteal lesions ≥10 cm and better than traditional endovascular treatment. In a real world setting of TASC C and D lesions, the provisional stent rate in the DCB cohort is low.
authors.affiliation: 1 Angiology Division, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zeller
authors.forename: Aljoscha
authors.initials: A
authors.lastname: Rastan
authors.forename: Roland
authors.initials: R
authors.lastname: Macharzina
authors.forename: Gunnar
authors.initials: G
authors.lastname: Tepe
authors.forename: Matthias
authors.initials: M
authors.lastname: Kaspar
authors.forename: Jorge
authors.initials: J
authors.lastname: Chavarria
authors.forename: Ulrich
authors.initials: U
authors.lastname: Beschorner
authors.forename: Uwe
authors.initials: U
authors.lastname: Schwarzwälder
authors.forename: Thomas
authors.initials: T
authors.lastname: Schwarz
authors.forename: Elias
authors.initials: E
authors.lastname: Noory
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001783:Blood Flow Velocity; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D020099:Coated Materials, Biocompatible; D003251:Constriction, Pathologic; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000503:physiopathology; D011474:Prosthesis Design; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices; D014654:Vascular Patency
chemical_list: D002317:Cardiovascular Agents; D020099:Coated Materials, Biocompatible
keywords: drug-coated balloon; drug-eluting balloon; drug-eluting stent; femoropopliteal segment; occlusion; paclitaxel; peripheral artery disease; popliteal artery; provisional stenting; restenosis; stenosis; superficial femoral artery