Sex and lesion differences in front-cutting atherectomy-assisted endovascular revascularization

Background: Atherectomy-assisted endovascular revascularization has emerged as a promising treatment tool with high technical success rates in complex and calcified peripheral artery disease (PAD). Our aim was to evaluate sex-specific differences in patients undergoing atherectomy-assisted endovascular revascularization. Patients and methods: Consecutive patients with symptomatic PAD, undergoing rotational atherectomy were included in a prospective single-centre registry. Demographic and clinical data and lesion localization were recorded in men and women. The primary safety endpoint was vessel perforation and peripheral embolization. Secondary endpoints were clinically driven target lesion revascularization (CD-TLR) and mortality rates during follow-up. Results: Overall, 632 patients (847 lesions, median length = 18.0 cm) were analysed (244 women and 388 men). Median age was 78.0 (69.0-84.0) years. Women were older than men (p<.001), while CLTI, diabetes and BTK lesions were more common in men (65.4% versus 58.2%, p<.05, 53.1% versus 38.5%, p=.004, and 35.9% vs. 21.6%, p<.0001, respectively). Lesion length and complexity by TASC were similar in men and women, while men showed higher calcification by PACSS (p=.03). High procedural success rates (99.5%) and low complications rates were observed. Women received less stents than men in the femoropopliteal segment (p=.03). Complication rates were similar between men and women (1.3% versus 2.5%, p=.28 for perforation and 1.5% versus 2.9%, p=.25 for embolization). CD-TLR and mortality rates were similar in men and women. Conclusions: Our study confirms the safety and effectiveness of front cutting rotational atherectomy in men and women presenting with complex and symptomatic PAD. Patient safety was present in men and women, whereas CD-TLR rates were relatively low in both sexes.