Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
Discipline of Radiology, St. Clare's Mercy Hospital, St. John's, NL, Canada.
J Endovasc Ther. 2022 Dec;29(6):948-955. doi: 10.1177/15266028211068772. Epub 2022 Jan 5.
Multiple randomized controlled trials have shown that both drug coated balloons (DCBs) and bare metal stents (BMSs) significantly reduce restenosis in femoropopliteal lesions compared with plain balloon angioplasty. However, few studies have directly compared DCB and BMS treatments. Therefore, the goal of our study was to determine if the rate of target lesion revascularization (TLR) differs between DCB and BMS treatment at our center.
We performed a retrospective chart review of femoropopliteal interventions at a single center from 2009 to 2017. The intervention, patient and lesion characteristics, and TLR events were recorded. Exclusion criteria were loss of follow-up, death, bail-out stenting, and amputation within 60 days of treatment. Freedom from TLR was analyzed over a 3 year period with Kaplan-Meier survival curves. Cox hazard ratios were calculated to account for patient and lesion characteristics.
A total of 322 lesions (234 patients) treated with DCBs and 225 lesions (194 patients) treated with BMSs were included in this study. There were significant differences in baseline patient and lesion characteristics between groups-a greater proportion of women, patients with dyslipidemia, and lesions with popliteal involvement were treated with DCBs. There was no difference in the freedom from TLR between DCBs and BMSs. Accounting for patient and lesion characteristics, there was still no difference between DCBs and BMSs on the hazard of TLR. While our analysis did not detect a difference in the rate of TLR, there was a significant difference in the type of TLR. Compared with DCBs, a greater proportion of lesions initially treated with BMSs were retreated via surgical bypass rather than endovascular intervention, suggesting that lesions treated with DCBs may be more amenable to future endovascular intervention.
Our retrospective analysis showed no difference in the rate of TLR between lesions treated with DCBs and BMSs. However, DCBs were more often used in complicated lesions involving popliteal arteries and may also allow for easier endovascular reintervention.
多项随机对照试验表明，与普通球囊血管成形术相比，药物涂层球囊（DCB）和裸金属支架（BMS）均可显著降低股腘病变的再狭窄率。然而，很少有研究直接比较 DCB 和 BMS 治疗。因此，我们的研究目的是确定在我们中心，DCB 和 BMS 治疗的靶病变血运重建（TLR）率是否不同。
我们对 2009 年至 2017 年期间在一家单中心进行的股腘血管介入治疗进行了回顾性图表审查。记录了干预、患者和病变特征以及 TLR 事件。排除标准为失访、死亡、紧急支架置入和治疗后 60 天内截肢。采用 Kaplan-Meier 生存曲线分析 3 年无 TLR 生存率。计算 Cox 风险比以考虑患者和病变特征。
本研究共纳入 322 处病变（234 例患者）接受 DCB 治疗和 225 处病变（194 例患者）接受 BMS 治疗。两组患者和病变特征存在显著差异——更多的女性、血脂异常患者和累及腘动脉的病变接受了 DCB 治疗。DCB 和 BMS 之间的 TLR 无复发率无差异。考虑到患者和病变特征，DCB 和 BMS 之间的 TLR 风险仍然没有差异。虽然我们的分析未检测到 TLR 率的差异，但 TLR 的类型存在显著差异。与 DCB 相比，最初接受 BMS 治疗的病变中有更大比例通过手术旁路而不是血管内介入进行再治疗，这表明接受 DCB 治疗的病变可能更适合未来的血管内介入治疗。
我们的回顾性分析显示，接受 DCB 和 BMS 治疗的病变 TLR 率无差异。然而，DCB 更常用于涉及腘动脉的复杂病变，并且可能还允许更容易进行血管内再介入。
