Laser Atherectomy Combined With Drug-Coated Balloon Angioplasty Is Associated With Improved 1-Year Outcomes for Treatment of Femoropopliteal In-Stent Restenosis.

Autor:	Kokkinidis DG; 1 Division of Cardiology, Denver VA Medical Center and University of Colorado, Denver, CO, USA., Hossain P; 2 Vascular Center and Division of Cardiovascular Medicine, University of California, Davis, Sacramento, CA, USA., Jawaid O; 1 Division of Cardiology, Denver VA Medical Center and University of Colorado, Denver, CO, USA., Alvandi B; 2 Vascular Center and Division of Cardiovascular Medicine, University of California, Davis, Sacramento, CA, USA., Foley TR; 1 Division of Cardiology, Denver VA Medical Center and University of Colorado, Denver, CO, USA., Singh GD; 2 Vascular Center and Division of Cardiovascular Medicine, University of California, Davis, Sacramento, CA, USA., Waldo SW; 1 Division of Cardiology, Denver VA Medical Center and University of Colorado, Denver, CO, USA., Laird JR; 2 Vascular Center and Division of Cardiovascular Medicine, University of California, Davis, Sacramento, CA, USA., Armstrong EJ; 1 Division of Cardiology, Denver VA Medical Center and University of Colorado, Denver, CO, USA.
Jazyk:	angličtina
Zdroj:	Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists [J Endovasc Ther] 2018 Feb; Vol. 25 (1), pp. 81-88. Date of Electronic Publication: 2017 Dec 08.
DOI:	10.1177/1526602817745668
Abstrakt:	Purpose: To examine whether laser atherectomy combined with drug-coated balloons (laser + DCB) can improve the outcomes of femoropopliteal (FP) in-stent restenosis (ISR). Methods: A dual-center retrospective study was conducted of 112 consecutive patients (mean age 70.3±10.6 years; 86 men) with Tosaka class II (n=29; diffuse stenosis) or III (n=83; occlusion) FP-ISR lesions. Sixty-two patients (mean age 68.5±10 years; 51 men) underwent laser + DCB while the other 50 patients (mean age 72.5±10.8 years; 35 men) had laser atherectomy plus balloon angioplasty (laser + BA). Critical limb ischemia was the indication in 33% of the interventions. The average lesion length was 247 mm. A Cox regression hazard model was developed to examine the association between laser + DCB vs laser + BA; the results are presented as the hazard ratio (HR) and 95% confidence interval (CI). One-year target lesion revascularization (TLR) and reocclusion were estimated using the Kaplan-Meier method. Results: Overall procedure success was 98% and was similar between groups. Bailout stenting was less often required in the laser + DCB group (31.7% vs 58%, p=0.006). The combination of laser + DCB was associated with improved 12-month estimates for freedom from TLR (72.5% vs 50.5%, p=0.043) and freedom from reocclusion (86.7% vs 56.9%, p=0.003). Among patients with Tosaka III FP-ISR, combination therapy with laser + DCB was also associated with increased freedom from reocclusion (87.1% vs 57.1%, p=0. 028). On multivariable analysis, treatment with laser + DCB was associated with a significantly reduced risk of reocclusion (HR 0.08, 95% CI 0.17 to 0.38; p=0.002). Conclusion: When used for treatment of complex FP-ISR lesions, DCB angioplasty combined with laser atherectomy is associated with significantly reduced 1-year TLR and reocclusion rates.
Databáze:	MEDLINE
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