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 RR8. Directional Atherectomy Has Equivalent Outcomes to Percutaneous Transluminal Angioplasty and Stenting (PTA/Stent) in Patients with Severely Diseased Femoropopliteal Lesions: Justification to Leave Nothing

​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

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