Comparison of Outcomes for the Percutaneous Atherectomy Versus Balloon Angioplasty and/or Stenting in the Treatment of Femoropopliteal Disease

Objectives: Atherectomy use for the treatment of femoropopliteal lesions has significantly increased. This study aimed to assess the clinical benefits of percutaneous atherectomy (PA) over balloon angioplasty and/or stenting (PTA±stent) for the femoropopliteal arterial disease using a nationwide prospective multicenter registry. Methods: Using data from the Damoeum registry of the Korean Society for Vascular Surgery, we identified patients with revascularization due to lower extremity arterial disease. After excluding patients who underwent open and hybrid revascularization, we compared the clinical outcomes of patients with PA group versus PTA±stent group. We investigated the target lesion patency, and functional and safety outcomes during the follow-up. Results: A total of 424 patients were included in the final analysis; 90 in the PA group and 334 in the PTA±stent group. There were 344 men and 79 women (mean age; 71.1 years). The preprocedural an-kle-brachial index (ABI) was significantly increased in both groups (P=.015). When we compared 90 patients of PA group and 270 patients of the matched PTA±stent cohort (1:3 propensity-matched cohort), the overall 1-year primary patency rate was not significantly different (83.8% vs 80.0%, P = .895). However, the PA group showed a significantly lower risk of occlusion compared to the PTA±stent group during the follow-up (adjusted HR 0.01, P< .001). Overall mortality was similar in the two groups (P=.695). Conclusions: The use of atherectomy was not associated with improvement in target lesion patency. How-ever, the use of atherectomy devices demonstrated a significant reduction of target lesion occlusion during the follow-up.