Intraluminal vs Subintimal Drug-Coated Balloon Angioplasty for the Treatment of Femoropopliteal Chronic Total Occlusions

Taku Toyoshima ¹, Mitsuyoshi Takahara ², Osamu Iida ¹

⁰Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.

Jacc. Cardiovascular Interventions +

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March 13, 2024

View abstract on PubMed

Summary

Intraluminal drug-coated balloon (DCB) angioplasty shows better outcomes for femoropopliteal chronic total occlusions (CTO) than subintimal DCB angioplasty. This approach significantly reduces the risk of restenosis at one year.

Area Of Science

Vascular Surgery
Interventional Cardiology
Medical Devices

Background

Femoropopliteal (FP) chronic total occlusions (CTO) present a significant challenge in lower extremity artery disease management.
Drug-coated balloon (DCB) angioplasty is a therapeutic option, but the optimal approach (intraluminal vs. subintimal) for FP CTO remains unclear.
Systematic comparison of intraluminal versus subintimal DCB angioplasty for FP CTO outcomes is needed.

Purpose Of The Study

To compare the 1-year clinical outcomes of intraluminal and subintimal DCB angioplasty in patients with symptomatic FP CTO.
To evaluate the effectiveness of different DCB angioplasty techniques for treating complex femoropopliteal lesions.

Main Methods

A subanalysis of the POPCORN registry included 469 patients with symptomatic FP CTO treated with DCB angioplasty.
Intravascular ultrasound was used to determine wire passage strategy (intraluminal vs. subintimal).
Propensity score matching was employed to compare 1-year freedom from restenosis between the two groups.

Main Results

After propensity score matching, the intraluminal DCB angioplasty group demonstrated a significantly higher 1-year freedom from restenosis rate (84.2%) compared to the subintimal group (77.0%; P=0.024).
Subintimal DCB angioplasty was associated with an increased risk of restenosis, particularly in patients with severe calcification, low-dose DCB use, or smoking.
Median follow-up was 14.2 months, with restenosis occurring in 140 patients.

Conclusions

Intraluminal DCB angioplasty is superior to subintimal DCB angioplasty for treating femoropopliteal chronic total occlusions.
The intraluminal approach offers a significantly better 1-year rate of freedom from restenosis in FP CTO patients.
These findings support the preferential use of intraluminal DCB angioplasty for improved clinical outcomes in FP CTO.

Keywords:

drug-coated balloon endovascular therapy femoropopliteal lesions lower extremity arterial disease restenosis