Effectiveness of directional atherectomy with the drug-coated balloon method for long and heavily calcified superficial femoral artery lesions

Objectives: This study aimed to examine the mid-term results of patients who underwent directional atherectomy (DA) for vascular preparation before drug-coated balloon (DCB) angioplasty with superficial femoral artery lesions longer than 150 mm and severe calcification and compare these patients with those treated with DCB angioplasty alone. Patients and methods: This prospective study enrolled 76 patients (66 males, 10 females; mean age: 63.3+9.8 years; range 44 to 105 years) with calcific superficial femoral artery lesions longer than 150 mm treated with DA before DCB angioplasty or DCB angioplasty alone between May 2019 and November 2020. The patients were evaluated in two groups according to DA use: the DA+DCB group with 46 patients and the DCB group consisting of 30 patients. The results of these two methods were compared, and the outcomes were followed up for one year after the treatment. Primary outcomes were patency, freedom from target lesion revascularization, and unplanned amputation. Results: There was no statistically significant difference between the two groups in demographic features, risk factors, comorbidity, and functional capacity assessment tests. At the 12th month, the primary patency of the DCB and DA+DCB group was 66.6% and 82.6%, respectively (p<0.05). Although the bail-out stent requirement rate for the treatment of the flow-limiting dissection (type C-F) was lower in the DA+DCB group (8.6% vs. 10.0%), there was no statistically significant difference (p=0.46). Conclusion: The DA prior to DCB in long segment severe calcific superficial femoral artery lesions may provide better patency and may decrease rate of flow-limiting and non-flow limiting dissections.