Impact of Postoperative Lumen Gain on the Reduction of Restenosis Risk After Endovascular Treatment Using Drug-coated Balloon for Femoropopliteal Lesions Assessed by Intravascular Ultrasound

Overview

Journal J Atheroscler Thromb

Date 2022 Nov 27

PMID 36436877

Authors

Kazunori Horie

Mitsuyoshi Takahara

Tatsuya Nakama

Akiko Tanaka

Kazuki Tobita

Naoki Hayakawa

Shinsuke Mori

Yo Iwata

Kenji Suzuki

Affiliations

Soon will be listed here.

Abstract

Aim: This study aimed to reveal whether a larger postprocedural minimum lumen area (MLA) would reduce restenosis risk after endovascular therapy (EVT) using drug-coated balloons (DCBs) in femoropopliteal (FP) lesions.

Methods: This retrospective, nonrandomized, single-arm, and multicenter registry analyzed patients with FP lesions undergoing intravascular ultrasound (IVUS)-guided EVT with DCB between 2017 and 2021. The primary outcome was restenosis 1 year after EVT. The association between IVUS-based MLA and restenosis risk was investigated using a generalized propensity score (GPS) method to address imbalance of baseline covariates. The dose-response function of IVUS-measured MLA for restenosis risk was developed using the GPS-adjusted Cox proportional hazards regression model.

Results: This study enrolled consecutive 489 patients with 595 lesions undergoing DCB treatment. The median MLA (interquartile range) was 13.20 (9.90-16.91) mm. Kaplan-Meier estimates showed that freedom from restenosis was 84.4% at 1 year. The GPS-adjusted dose-response function showed that MLA was inversely associated with restenosis risk. The upper limit of 95% confidence interval (CI) of the slope was lower than 0 between 10.6 and 17.0 mm of MLAs. The 1-year cumulative incidence of restenosis was estimated to be 9.8% (95% CI, 5.8%-13.7%) for the 3rd quartile of MLA (16.91 mm) versus 18.5% (12.3%-24.1%) for the 1st quartile (9.90 mm), with a hazard ratio of 0.51 (95% CI, 0.39-0.67; p＜0.001).

Conclusions: The present GPS analysis suggested that larger IVUS-measured MLA might be associated with lower risk of 1-year restenosis after DCB treatment for FP lesions.

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