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Impact of Stepwise Balloon Angioplasty for De Novo Femoropopliteal Artery: A Retrospective Observational Study
Takahiro Tokuda1, Ryoji Koshida2, Naoki Yoshioka3
1Department of Cardiology Nagoya Heart Center Nagoya Japan.
Insights
Stepwise balloon angioplasty for femoropopliteal artery disease significantly reduces severe dissections and bail-out stenting compared to conventional methods. This approach enhances procedural safety in endovascular treatments.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Drug-coated balloons improve patency in femoropopliteal (FP) lesions.
- Conventional balloon angioplasty risks severe artery dissection.
- Stepwise balloon angioplasty may mitigate dissection risks.
Purpose of the Study:
- To evaluate the efficacy of stepwise balloon angioplasty in de novo FP artery disease.
- To compare stepwise versus conventional balloon angioplasty outcomes.
- To assess the impact on dissection, stenting, and revascularization rates.
Main Methods:
- Retrospective analysis of 549 FP lesions from August 2018 to December 2021.
- Propensity score matching to compare stepwise and conventional balloon angioplasty in 129 matched pairs.
- Outcomes assessed: dissection severity, bail-out stenting, complications, and 1-year clinically driven target lesion revascularization (CD-TLR).
Main Results:
- Stepwise angioplasty showed significantly lower rates of severe dissection (Type D or higher) (14.0% vs. 24.0%, p=0.04).
- Bail-out stenting rates were also significantly lower with stepwise angioplasty (3.1% vs. 9.4%, p=0.03).
- No significant differences were observed in procedural complications or CD-TLR rates between the groups.
Conclusions:
- Stepwise balloon angioplasty is associated with reduced severe dissection and bail-out stenting in FP artery disease.
- This technique offers a potentially safer alternative to conventional angioplasty.
- Further research may confirm long-term clinical benefits.
Background And Aims:
Drug-coated balloon use in the revascularisation of femoropopliteal (FP) lesions improves patency rates. However, conventional balloon angioplasty sometimes leads to severe artery dissection, which may be prevented using stepwise balloon angioplasty. This study aimed to examine the effects of stepwise balloon angioplasty, which is defined as a step-up approach with a sequentially larger balloon size, on de novo FP artery disease.
Methods:
A retrospective analysis was performed using data collected from patients who underwent endovascular treatment for FP artery disease between August 2018 and December 2021 at eight institutions. During this period, 549 FP lesions were analyzed, and propensity score matching analysis was performed to compare stepwise and conventional balloon angioplasties. The prognostic value was assessed based on the angiographic dissection pattern, rate of bail-out stenting, procedural complications, and rate of clinically driven target lesion revascularisation (CD-TLR) within 1 year.
Results:
Propensity score matching was used to analyze 129 matched pairs of patients. The incidence of severe vessel dissection, defined as Type D or higher, and the rate of bail-out stenting were significantly higher in conventional balloon angioplasty compared to stepwise balloon angioplasty (24.0% vs. 14.0%, p = 0.04; and 9.4% vs. 3.1%, p = 0.03, respectively). There were no significant differences between the two groups in procedural complications or the rate of CD-TLR.
Conclusion:
Severe dissection and bail-out stenting rates were lower after stepwise balloon angioplasty.
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