Intravascular Lithotripsy and Drug-Coated Balloon Angioplasty for Severely Calcified Common Femoral Artery Atherosclerotic Disease.

Autor:	Stavroulakis K; Department of Vascular Surgery, Ludwig-Maximilians-University Hospital Munich, Munich, Germany., Torsello G; Department of Vascular Surgery, St. Franziskus-Hospital GmbH, Münster, Germany., Chlouverakis G; Biostatistics Laboratory, Department of Social Medicine, School of Medicine, University of Crete, Rethymno, Greece., Bisdas T; Department of Vascular and Endovascular Surgery, Athens Medical Center, Marousi, Greece., Damerau S; Department of Vascular Surgery, St. Franziskus-Hospital GmbH, Münster, Germany., Tsilimparis N; Department of Vascular Surgery, Ludwig-Maximilians-University Hospital Munich, Munich, Germany., Argyriou A; Department of Vascular Surgery, Marien Hospital Herne, Herne, Germany.
Jazyk:	angličtina
Zdroj:	Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists [J Endovasc Ther] 2024 Dec; Vol. 31 (6), pp. 1165-1172. Date of Electronic Publication: 2023 Mar 10.
DOI:	10.1177/15266028231158313
Abstrakt:	Objectives: Intravascular lithotripsy (IVL) followed by drug-coated balloon (DCB) angioplasty might be a valuable alternative to surgery for calcified common femoral artery (CFA) atherosclerotic disease. Nonetheless, the 12 months performance of this treatment strategy remains unknown. This study reports on the 12 months outcomes of IVL with adjunctive DCB angioplasty for calcified CFA lesions. Methods: This is a retrospective single-center, single-arm study. Consecutive patients treated by IVL and DCB for calcified CFA disease between February 2017 and September 2020 were evaluated. The primary measure outcome of this analysis was primary patency. Procedural technical success (<30% stenosis), freedom from target lesion revascularization (TLR), secondary patency, and overall mortality were additionally analyzed. Results: Thirty-three (n=33) patients were included in this study. The majority presented with lifestyle limiting claudication (n=20, 61%), 52% (n=17) of the patients had chronic kidney disease (CKD) and 33% (n=11) had diabetes. The procedural technical success was 97% (n=32). A flow-limiting dissection post IVL was observed in 2 patients (6%) and a peripheral embolization in a single patient (3%), while the bail-out stenting rate amounted to 12% (n=4). No perforation was observed. The median length of hospital stay was 2 days (interquartile range 2-3). At 12 months, the primary patency was 72%. The freedom from TLR and the secondary patency rates were 94% and 88%, respectively. The 12-month survival amounted to 100% and 75% (n=25) of the patients were asymptomatic or presented with mild claudication. The presence of chronic limb-threatening ischemia (CLTI) (hazard ratio [HR], 0.92; confidence interval (CI); 0.18-4.8, p=0.7) or CKD (HR, 1.30; 95% CI, 0.29-5.8; p=0.72), as well as the use of a 7 mm IVL catheter (HR, 0.59; 95% CI, 0.13-2.63; p=0.49) or of high-dose DCB (HR, 0.68; 95% CI, 0.13-3.53; p=0.65) did not influence the primary patency. Conclusions: In this study, the combination of IVL and DCB angioplasty for calcified CFA disease was associated with low risk for periprocedural complications, acceptable 12 months clinical outcomes, and low rates of reinterventions. Clinical Impact: Intravascular lithotripsy in combination with DCB angioplasty can be an alternative to surgery in highly selected patients with CFA atherosclerotic disease. In this Cohort the combination therapy lead to acceptable clinical results and low reintervention rates at 12 months. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Konstantinos Stavroulakis has received consulting fees for Phillips, Shockwave, Boston Scientific, and Terumo, and received Honoraria from Medtronic, Bentley, and Biotronik, Giovanni Torsello has received consulting fees for Medtronic and Boston Scientific, and received grants from Medtronic, Gore, Cook, and Cordis, Theodosios Bisdas has received consulting fees for Boston Scientific, Medtronic, BARD, and COOK Medical.
Databáze:	MEDLINE
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