Balloon angioplasty plus stenting or atherectomy plus drug-coated balloon angioplasty in endovascular repair of the common femoral artery.

Abstract

Endovascular treatment of common femoral artery (CFA) lesions has emerged as an alternative to surgical endarterectomy, with two main strategies: balloon angioplasty and stenting vs atherectomy plus drug-coated balloon (DCB) angioplasty. However, the optimal endovascular approach for CFA lesions remains to be defined. This single-center retrospective study analyzed consecutive patients with symptomatic atheromatous CFA stenosis requiring endovascular treatment between January 2016 and January 2024. Patients were stratified by approach. The primary end point was 12-month primary patency, defined as duplex ultrasound peak systolic velocity ratios of ≤2.4 without clinically driven target lesion revascularization (TLR). Secondary end points included freedom from TLR, technical success and primary sustained clinical improvement. A total of 134 limbs of 138 patients were included in the final analysis, 39 in the atherectomy plus DCB group and 95 in the plain old balloon angioplasty plus stenting group. Baseline demographic and clinical characteristics were comparable between the groups, with mean ages of 74 ± 8 years for atherectomy plus DCB angioplasty and 72 ± 8 years for stenting (P = .14). Technical success was achieved in 89.2% of atherectomy plus DCB angioplasty cases compared with 92.3% of stenting procedures (P = .52). The 12-month primary patency rates were similar between the groups: 79.5% for atherectomy plus DCB angioplasty vs 78.7% for stenting (P = .71). Freedom from TLR was 92.3% and 85.3%, respectively (P = .56). Bailout stenting was required in 10% of atherectomy cases, and stent fractures occurred in 5.3% of the stenting cohort. Atherectomy plus DCB angioplasty and stenting demonstrated similar 12-month outcomes for CFA lesions. Both strategies represent viable endovascular options. Multicenter randomized trials are warranted to establish optimal treatment strategies.