title: Drug-Eluting Balloon Therapy for Femoropopliteal Occlusive Disease: Predictors of Outcome With a Special Emphasis on Calcium.
abstract: OBJECTIVE
  To assess the association of patient, lesion, and procedure variables, including calcification, with late lumen loss (LLL) after use of drug-eluting balloon (DEB) therapy in patients with femoropopliteal arterial disease.
  
  
  METHODS
  In this retrospective study, 91 patients (mean age 72.0±8.62 years; 50 men) were analyzed at 6 months after DEB treatment. Lesions were located in the superficial femoral artery (SFA, n=68) and popliteal artery (n=23). Lesion calcification was graded by a core laboratory using 2 published scoring indices: the peripheral artery calcification scoring system and a grading system based on circumference (arc) and length of calcium.
  
  
  RESULTS
  The median LLL after 6 months was 0.2 mm (interquartile range -0.5, 1.14) overall and varied significantly across lesions with differing severity of calcification (p=0.042). However, LLL did not differ based on calcium location (intimal, medial, or mixed) or calcium length (p=0.351 and p=0.258, respectively). Additional predictors of LLL after DEB treatment included diabetes (p=0.034), coronary artery disease (p=0.024), and prior intervention (p=0.013). Interestingly, the severity of residual stenosis after the intervention did not have any impact on the LLL during follow-up (Spearman r = -0.238).
  
  
  CONCLUSIONS
  Severity of lesion calcification is associated with LLL after treatment with DEB. One possible approach to overcome this limitation might be plaque modification or removal prior to DEB usage. Nevertheless, clinical data that support this hypothesis are currently lacking.
authors.affiliation: Institute for Diagnostic and Interventional Radiology, RoMed Hospital, Rosenheim, Germany gunnar.tepe@ro-med.de.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Tepe
authors.affiliation: Department of Angiology, Clinical for Cardiology and Angiology II, Universitaets-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Beschorner
authors.affiliation: Institute for Diagnostic and Interventional Radiology, RoMed Hospital, Rosenheim, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Ruether
authors.affiliation: Department of Biostatistics, Tuebingen, Germany.
authors.forename: Imma
authors.initials: I
authors.lastname: Fischer
authors.affiliation: Institute for Diagnostic and Interventional Radiology, RoMed Hospital, Rosenheim, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Pfaffinger
authors.affiliation: Department of Angiology, Clinical for Cardiology and Angiology II, Universitaets-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Elias
authors.initials: E
authors.lastname: Noory
authors.affiliation: Department of Angiology, Clinical for Cardiology and Angiology II, Universitaets-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zeller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D020099:Coated Materials, Biocompatible; D003251:Constriction, Pathologic; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000628:therapy*; D011150:Popliteal Artery; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices; D061205:Vascular Calcification / Q000175:diagnosis / Q000628:therapy*
chemical_list: D002317:Cardiovascular Agents; D020099:Coated Materials, Biocompatible
keywords: angioplasty; calcification; drug-coated balloon; drug-eluting balloon; late lumen loss; peripheral artery disease; popliteal artery; superficial femoral artery