title: Mid-term outcomes of orbital atherectomy combined with drug-coated balloon angioplasty for treatment of femoropopliteal disease.
abstract: OBJECTIVE
  To assess the intraprocedural and mid-term outcomes of orbital atherectomy (OA) combined with drug-coated balloon (DCB) angioplasty for the treatment of calcified femoropopliteal disease.
  
  
  METHODS
  In this single-center cohort, 89 patients (139 lesions) were treated with DCB angioplasty for claudication or critical limb ischemia (CLI). Angiographic characteristics and procedural outcomes were reviewed for patients treated with or without adjunctive OA. Lesion calcification was graded using two previously published scoring systems, the angiographic calcium score (ACS) and the peripheral artery calcification scoring system (PACSS).
  
  
  RESULTS
  Among 139 lesions, 40 (29%) were treated with OA + DCB. Mean lesion length was 135 ± 100 mm for lesions treated with OA + DCB and 139 ± 100 mm for DCB alone (P = 0.9). Moderate to severe calcification was present in 83% of patients treated with OA, compared to 42% of patients treated with DCB alone (P < 0.001). Lesions treated with OA + DCB were less likely to require bailout stenting (18% vs. 39%, P =0.01). Rates of embolization (0% in OA + DCB vs. 2% in DCB only, P = 0.4), dissection (13% vs. 14%, P = 0.8), and perforation (0%) did not differ significantly between groups. The freedom from TLR at 1 year was 82% in both groups (P = 0.6) while primary patency was 81% in-patients treated with DCB alone and 77% in-patients treated with DCB with concomitant OA (P = 0.8).
  
  
  CONCLUSIONS
  In this single-center analysis of patients undergoing DCB angioplasty for claudication or CLI, OA was most often used for the treatment of severely calcified lesions. These lesions were more likely to be treated with scoring balloons and less likely to require bailout stenting. At 1 year, target lesion revascularization and primary patency was similar in patients treated with and without adjunctive OA, despite the higher lesion complexity among those receiving the combination procedure. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: T Raymond
authors.identifier: http://orcid.org/0000-0002-3121-9748
authors.initials: TR
authors.lastname: Foley
authors.affiliation: Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Cotter
authors.affiliation: Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Damianos G
authors.initials: DG
authors.lastname: Kokkinidis
authors.affiliation: Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Nguyen
authors.affiliation: Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Stephen W
authors.identifier: http://orcid.org/0000-0003-0678-4873
authors.initials: SW
authors.lastname: Waldo
authors.affiliation: Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Ehrin J
authors.identifier: http://orcid.org/0000-0002-5682-8363
authors.initials: EJ
authors.lastname: Armstrong
mesh_terms: D000368:Aged; D000792:Angiography; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D017073:Atherectomy / Q000009:adverse effects; D020099:Coated Materials, Biocompatible; D003120:Colorado; D016638:Critical Illness; D018572:Disease-Free Survival; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D007511:Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D014654:Vascular Patency
chemical_list: D020099:Coated Materials, Biocompatible
keywords: calcification; peripheral artery disease; peripheral intervention; superficial femoral artery