In the Journals

Treatment with DCB, laser atherectomy beneficial in PAD, restenosis

Nicolas W. Shammas

Patients with complex femoropopliteal in-stent restenosis lesions benefited from treatment with laser atherectomy and a drug-coated balloon, researchers reported.

In a retrospective study of 112 patients (mean age, 70 years; 23% women; 33% with critical limb ischemia) with Tosaka class II or III femoropopliteal in-stent restenosis lesions (mean lesion length, 247 mm), the researchers compared 62 patients treated with laser atherectomy (Turbo Elite, Turbo-Power or Turbo Tandem; Spectranetics) and a DCB (IN.PACT Admiral, Medtronic; Lutonix, Bard Peripheral Vascular) vs. 50 treated with laser atherectomy and balloon angioplasty.

The outcomes of interest were target lesion revascularization and reocclusion at 1 year.

The rate of procedural success was 98% and was similar in both groups, Damianos G. Kokkinidis, MD, from the division of cardiology at Denver VA Medical Center and the University of Colorado, Denver, and colleagues wrote.

Bailout stenting was needed in 31.7% of the laser/DCB group vs. 58% of the laser/plain balloon group (P = .006), according to the researchers.

At 1 year, freedom from TLR was estimated in 72.5% of the laser/DCB group and in 50.5% of the laser/plain balloon group (P = .043), they wrote.

The 1-year estimate of freedom from reocclusion was 86.7% in the laser/DCB group and 56.9% in the laser/plain balloon group (P = .003), which was significant on multivariable analysis (HR = 0.08; 95% CI, 0.17-0.38), Kokkinidis and colleagues wrote.

In a sensitivity analysis of patients with Tosaka class III lesions (n = 83), 1-year freedom from reocclusion was more common in the laser/DCB group (87.1% vs. 57.1%; P = .028).

“The mechanisms underlying the benefit from combined treatment with laser atherectomy plus DCBs are likely multifactorial,” Kokkinidis and colleagues wrote. “Laser atherectomy and DCB angioplasty have synergistic mechanisms of action that result in the large, clinically meaningful benefit observed in our cohort.”

In a related editorial, Nicolas W. Shammas, MD, MS, EJD, president and research director of Midwest Cardiovascular Research Foundation in Davenport, Iowa, wrote: “The main question that remains is whether there is an additive or synergistic effect of laser plus DCB compared with DCB alone. It is recognized that the acute success of the procedure is significantly improved with the laser compared with [balloon angioplasty]. Clinical outcomes are needed, however, to justify the added expense. ... Whether a statistical difference between laser plus DCB vs. DCB alone truly exists will need to be proven in randomized trials.” – by Erik Swain

Disclosures: Kokkinidis reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Shammas reports he receives research and educational grants from Boston Scientific and C.R. Bard.

 

 

Nicolas W. Shammas

Patients with complex femoropopliteal in-stent restenosis lesions benefited from treatment with laser atherectomy and a drug-coated balloon, researchers reported.

In a retrospective study of 112 patients (mean age, 70 years; 23% women; 33% with critical limb ischemia) with Tosaka class II or III femoropopliteal in-stent restenosis lesions (mean lesion length, 247 mm), the researchers compared 62 patients treated with laser atherectomy (Turbo Elite, Turbo-Power or Turbo Tandem; Spectranetics) and a DCB (IN.PACT Admiral, Medtronic; Lutonix, Bard Peripheral Vascular) vs. 50 treated with laser atherectomy and balloon angioplasty.

The outcomes of interest were target lesion revascularization and reocclusion at 1 year.

The rate of procedural success was 98% and was similar in both groups, Damianos G. Kokkinidis, MD, from the division of cardiology at Denver VA Medical Center and the University of Colorado, Denver, and colleagues wrote.

Bailout stenting was needed in 31.7% of the laser/DCB group vs. 58% of the laser/plain balloon group (P = .006), according to the researchers.

At 1 year, freedom from TLR was estimated in 72.5% of the laser/DCB group and in 50.5% of the laser/plain balloon group (P = .043), they wrote.

The 1-year estimate of freedom from reocclusion was 86.7% in the laser/DCB group and 56.9% in the laser/plain balloon group (P = .003), which was significant on multivariable analysis (HR = 0.08; 95% CI, 0.17-0.38), Kokkinidis and colleagues wrote.

In a sensitivity analysis of patients with Tosaka class III lesions (n = 83), 1-year freedom from reocclusion was more common in the laser/DCB group (87.1% vs. 57.1%; P = .028).

“The mechanisms underlying the benefit from combined treatment with laser atherectomy plus DCBs are likely multifactorial,” Kokkinidis and colleagues wrote. “Laser atherectomy and DCB angioplasty have synergistic mechanisms of action that result in the large, clinically meaningful benefit observed in our cohort.”

In a related editorial, Nicolas W. Shammas, MD, MS, EJD, president and research director of Midwest Cardiovascular Research Foundation in Davenport, Iowa, wrote: “The main question that remains is whether there is an additive or synergistic effect of laser plus DCB compared with DCB alone. It is recognized that the acute success of the procedure is significantly improved with the laser compared with [balloon angioplasty]. Clinical outcomes are needed, however, to justify the added expense. ... Whether a statistical difference between laser plus DCB vs. DCB alone truly exists will need to be proven in randomized trials.” – by Erik Swain

Disclosures: Kokkinidis reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Shammas reports he receives research and educational grants from Boston Scientific and C.R. Bard.