title: Directional Atherectomy With Antirestenotic Therapy vs Drug-Coated Balloon Angioplasty Alone for Isolated Popliteal Artery Lesions.
abstract: To report a single-center study comparing drug-coated balloon (DCB) angioplasty vs directional atherectomy with antirestenotic therapy (DAART) for isolated lesions of the popliteal artery.
  
  
  
  Seventy-two patients were treated with either DCB angioplasty alone (n=31) or with DAART (n=41) for isolated popliteal artery stenotic disease between October 2009 and December 2015. The majority of patients presented with lifestyle-limiting claudication (74% vs 86%, respectively). Vessel calcification (29% vs 29%, respectively), mean lesion length (47 vs 42 mm, respectively), and number of runoff vessels were comparable between the groups. The primary outcome measure was primary patency; secondary outcomes were technical success (<30% residual stenosis or bailout stenting), secondary patency, and freedom from clinically driven target lesion revascularization (TLR).
  
  
  
  The technical success rate following DCB was 84% vs 93% (p=0.24) after DAART. The 12-month primary patency rate was significantly higher in the DAART group (65% vs 82%; hazard ratio 2.64, 95% confidence interval 1.09 to 6.37, p=0.021), while freedom from TLR did not differ between the 2 treatment strategies (82% vs 94%, p=0.072). Secondary patency at 12 months was identical for both groups (96% vs 96%). Although not statistically significant, bailout stenting was more common after DCB angioplasty (16% vs 5% for DAART, p=0.13) and aneurysmal degeneration of the popliteal artery was seen more often after DAART (7% vs 0% for DCB alone, p=0.25). Popliteal artery injury was observed in 2 patients treated using DAART (5% vs 0% for DCB alone, p=0.5), whereas distal embolization rates were comparable between the groups (3% for DCB alone vs 5% for DAART, p=0.99).
  
  
  
  In this study, the use of DAART was associated with a higher primary patency rate compared with DCB angioplasty for isolated popliteal lesions. Nonetheless, both treatment options were associated with excellent 12-month secondary patency. Aneurysmal degeneration of the popliteal artery and increased bailout stenting could compromise the outcomes of DAART and DCB, respectively.
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, University of Münster, Germany.|2 Department of Vascular Surgery, St Franziskus-Hospital GmbH Münster, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Stavroulakis
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, University of Münster, Germany.|2 Department of Vascular Surgery, St Franziskus-Hospital GmbH Münster, Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: Schwindt
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, University of Münster, Germany.|2 Department of Vascular Surgery, St Franziskus-Hospital GmbH Münster, Germany.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Torsello
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, University of Münster, Germany.|2 Department of Vascular Surgery, St Franziskus-Hospital GmbH Münster, Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: Stachmann
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, University of Münster, Germany.|2 Department of Vascular Surgery, St Franziskus-Hospital GmbH Münster, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Hericks
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, University of Münster, Germany.|2 Department of Vascular Surgery, St Franziskus-Hospital GmbH Münster, Germany.
authors.forename: Michel J
authors.initials: MJ
authors.lastname: Bosiers
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, University of Münster, Germany.|2 Department of Vascular Surgery, St Franziskus-Hospital GmbH Münster, Germany.
authors.forename: Efthymios
authors.initials: E
authors.lastname: Beropoulis
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, University of Münster, Germany.|2 Department of Vascular Surgery, St Franziskus-Hospital GmbH Münster, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Stahlhoff
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, University of Münster, Germany.|2 Department of Vascular Surgery, St Franziskus-Hospital GmbH Münster, Germany.
authors.forename: Theodosios
authors.initials: T
authors.lastname: Bisdas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000209:etiology; D000792:Angiography; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D000925:Anticoagulants / Q000008:administration & dosage; D017073:Atherectomy / Q000009:adverse effects / Q000379:methods*; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D020099:Coated Materials, Biocompatible; D003251:Constriction, Pathologic; D004867:Equipment Design; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage* / Q000009:adverse effects; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices; D014654:Vascular Patency
chemical_list: D000925:Anticoagulants; D002317:Cardiovascular Agents; D020099:Coated Materials, Biocompatible; D010975:Platelet Aggregation Inhibitors; D017239:Paclitaxel
keywords: angioplasty; atherectomy; complications; drug-coated balloon; drug-eluting balloon; occlusion; popliteal artery; reintervention; stenosis; stent