Atherectomy versus Stent Placement for Common Femoral Artery Atherosclerotic Disease: A Systematic Review

To compare the outcomes of atherectomy versus stent placement for common femoral artery (CFA) symptomatic atherosclerosis.

This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in PROSPERO. MEDLINE and Embase databases were searched for records from 2000 to 2023. The following data were extracted and tabulated: (a) characteristics of studies, (b) patients, (c) lesions and interventions, and (d) clinical and technical outcomes. Risk of bias was assessed using Mixed Methods Appraisal Tool (MMAT).

The search identified 2,088 references, of which 33 studies were included: 11 reported only on atherectomy, 20 reported only on stent placement, and 2 reported on both treatments. Atherectomy and stent placement studies were comparable in terms of age, sex, prevalence of comorbidities, chronic limb ischemia, preprocedural Rutherford score, and ankle-brachial index. Technical success ranged across the studies from 92% to 100% for atherectomy versus 94% to 100% for stent placement, periprocedural adverse event rates ranged from 0% to 24% versus 0% to 19%, rates of freedom from target lesion revascularization ranged from 83% to 100% versus 81% to 100%, and limb salvage rates ranged from 85% to 100% versus 94% to 100%. Stent fracture rates ranged from 0% to 8%. Only 5 of 13 studies on atherectomy and 5 of 22 studies on stent placement met all 7 MMAT criteria.

This systematic review demonstrates satisfactory outcomes with both methods, with no clear advantage of one technique over the other. However, available data on these 2 techniques are heterogeneous. Future studies are necessary to conclude if either technique is superior for the treatment of symptomatic CFA atherosclerosis.