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

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

Materials and methods: 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).

Results: 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.

Conclusions: 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.