In-Kyong Kim1, Natalia N. Egorova2, James F. McKinsey1
1Surgery, New York-Presbyterian Hospital, Columbia University, New York, NY; 2Mount Sinai School of Medicine, New York, NY.
OBJECTIVES: To compare the efficacy of PTA/stent and directional atherectomy for the severely diseased femoropopliteal lesions with risk factors shown to decrease patency
METHODS: All EVT for femoropopliteal lesions from 2005 to 2009 at our institution were reviewed. Patency was evaluated by Kaplan-Meier analysis.
RESULTS: Of 1,776 lesions in our prospective database, 1,329 discrete femoropopliteal lesions in 675 patients (56.4% male, age 72.4) were subjected to analysis. Procedures included: 867 PTA/stent and 375 atherectomy. The two procedures led to no significant difference in patency of lesions that have characteristics that predispose interventions to failure (Table): diabetes (p=0.95), CHF (p=0.64), lesions length,>100,mm (p=0.07), 80-90% stenosis (p=0.90), or chronic total occlusion(CTO) (p=0.34). Further, using the weighted Disease Severity Score (DSS) shown to be well correlated with patency (Scored as: diabetes=1, CHF=1, length,>100,mm=2, 80-90% stenosis=2, CTO=3), the primary patency rate of PTA/stent and atherectomy was not statistically different even for severely diseased lesions (DSS 6-7) (p=0.24).
CONCLUSIONS: Both PTA/stent and atherectomy have equivalent and reasonable primary patency for lesions with risk factors shown to significantly decrease patency and can be used as the first-line modality. Further, our analysis shows non-inferiority of atherectomy, and therefore a therapeutic option even for lesions considered severely diseased, with the added advantage of eliminating the need for a foreign body (stent).
AUTHOR DISCLOSURES: N. N. Egorova, Nothing to disclose; I. Kim, Nothing to disclose; J. F. McKinsey, EVIII Committee, Speaker’s bureau Pathway Medical, Speaker’s bureau Cook Medical, Research Grants Educational Committee, Honorarium.
Primary Patency
|
6-months |
12-months |
24-months |
PTA/Stent |
Atherectomy |
PTA/Stent |
Atherectomy |
PTA/Stent |
Atherectomy |
DM |
78.2 [71.1-83.8] |
75.9 [70.8-80.3] |
57.3 [49.0-64.8] |
58.0 [52.1-63.5] |
42.2 [33.8-50.7] |
41.8 [35.4-48.1] |
CHF |
75.9 [64.8-83.9] |
70.6 [62.6-77.2] |
55.1 [43.1-65.6] |
48.9 [39.8-57.4 |
36.8 [25.3-48.4] |
39.6 [30.0-49.0] |
Lesion Length >100mm |
72.1 [63.0-79.3] |
77.4 [72.0-81.8] |
49.1 [39.4-58.1] |
54.0 [47.6-60.0] |
31.8 [22.7-41.3] |
38.0 [31.4-44.5] |
Lesion 80-90% Stenosis |
81.1 [73.4-86.7] |
79.8 [74.2-84.3] |
61.6 [52.6-69.4] |
61.7 [54.9-67.8] |
46.3 [36.7-55.2] |
50.4 [43.1-57.3] |
CTO |
69.1 [59.6-76.8] |
75.7 [68.3-81.6] |
53.8 [43.8-62.8] |
53.5 [45.0-61.3] |
37.5 [27.6-47.4] |
35.2 [26.8-43.7] |
Severe Lesions (DSS 6-7) |
79.6 [66.2-88.2] |
66.2 [55.9-74.6] |
49.4 [34.7-62.6] |
41.5 [31.0-51.6] |
31.4 [18.2-45.5] |
23.5 [14.5-22.7] |
Posted April 2012