A Pilot Study of Femoropopliteal Artery Revascularisation with a Low Dose Paclitaxel Coated Balloon: Is Predilatation Necessary?

• Published in: European journal of vascular and endovascular surgery 2017-09, Vol.54 (3), p.348-355
• Main Authors: Schroeder, H., Meyer, D.-R., Lux, B., Ruecker, F., Martorana, M., Miller, L.E., Duda, S.
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon - adverse effects; Angioplasty, Balloon - instrumentation; Ankle Brachial Index; Balloon angioplasty; Cardiovascular Agents - administration & dosage; Cardiovascular Agents - adverse effects; Chi-Square Distribution; Coated Materials, Biocompatible; Constriction, Pathologic; Female; Femoral artery; Femoral Artery - diagnostic imaging; Femoral Artery - physiopathology; Germany; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Paclitaxel; Paclitaxel - administration & dosage; Paclitaxel - adverse effects; Peripheral arterial disease; Peripheral Arterial Disease - diagnosis; Peripheral Arterial Disease - physiopathology; Peripheral Arterial Disease - therapy; Pilot Projects; Popliteal artery; Popliteal Artery - diagnostic imaging; Popliteal Artery - physiopathology; Propensity Score; Proportional Hazards Models; Prospective Studies; Prosthesis Design; Revascularisation; Time Factors; Treatment Outcome; Vascular Access Devices; Vascular Patency
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2017.06.020

The objective was to compare 2 year outcomes in patients treated with or without predilatation prior to drug coated balloon (DCB) angioplasty for symptomatic femoropopliteal lesions. This prospective multicentre pilot study was conducted at three sites in Germany. It compared claudicants undergoing predilatation with a bare percutaneous transluminal angioplasty (PTA) balloon before DCB (predilatation group) with patients undergoing direct DCB (direct DCB group). Patients were followed for 2 years. Outcomes included late lumen loss at 6 months, and ankle brachial index (ABI), major adverse events, and primary patency at 2 years. A Clinical Events Committee and core laboratories analysed adverse events and angiographic/duplex images, respectively. Between December 2011 and November 2012, 50 patients were enrolled to the predilatation group (12% total occlusions) and 28 to the direct DCB group (5% total occlusions). Follow-up compliance at the 2 year visit was 88% (n = 44) and 86% (n = 24), respectively. Late lumen loss at 6 months was lower in the direct DCB group (0.03 ± 0.68 mm vs. 0.54 ± 0.97 mm; p = .01). Major adverse events over 2 years occurred in seven (15%) patients who underwent predilatation and in five (19%) after direct DCB. Mean ABI at 2 years was 0.94 ± 0.15 after predilatation and 1.0 ± 0.12 after direct DCB. Over 2 years, primary patency (80.3% vs. 78.2%; p = .55) was not statistically different between the groups. After propensity score adjustments, 2 year findings remained unchanged. Paclitaxel coated PTA, with or without bare predilatation, is effective over 2 years in symptomatic patients with femoropopliteal stenotic lesions. Adequately powered randomised controlled comparisons are required to confirm these preliminary results.