%0 Journal Article
%T Laser Atherectomy Combined With Drug
%A Bejan Alvandi
%A Damianos G. Kokkinidis
%A Ehrin J. Armstrong
%A Gagan D. Singh
%A John R. Laird
%A Omar Jawaid
%A Prio Hossain
%A Stephen W. Waldo
%A T. Raymond Foley
%J Journal of Endovascular Therapy
%@ 1545-1550
%D 2018
%R 10.1177/1526602817745668
%X Purpose: To examine whether laser atherectomy combined with drug-coated balloons (laser + DCB) can improve the outcomes of femoropopliteal (FP) in-stent restenosis (ISR). Methods: A dual-center retrospective study was conducted of 112 consecutive patients (mean age 70.3¡À10.6 years; 86 men) with Tosaka class II (n=29; diffuse stenosis) or III (n=83; occlusion) FP-ISR lesions. Sixty-two patients (mean age 68.5¡À10 years; 51 men) underwent laser + DCB while the other 50 patients (mean age 72.5¡À10.8 years; 35 men) had laser atherectomy plus balloon angioplasty (laser + BA). Critical limb ischemia was the indication in 33% of the interventions. The average lesion length was 247 mm. A Cox regression hazard model was developed to examine the association between laser + DCB vs laser + BA; the results are presented as the hazard ratio (HR) and 95% confidence interval (CI). One-year target lesion revascularization (TLR) and reocclusion were estimated using the Kaplan-Meier method. Results: Overall procedure success was 98% and was similar between groups. Bailout stenting was less often required in the laser + DCB group (31.7% vs 58%, p=0.006). The combination of laser + DCB was associated with improved 12-month estimates for freedom from TLR (72.5% vs 50.5%, p=0.043) and freedom from reocclusion (86.7% vs 56.9%, p=0.003). Among patients with Tosaka III FP-ISR, combination therapy with laser + DCB was also associated with increased freedom from reocclusion (87.1% vs 57.1%, p=0. 028). On multivariable analysis, treatment with laser + DCB was associated with a significantly reduced risk of reocclusion (HR 0.08, 95% CI 0.17 to 0.38; p=0.002). Conclusion: When used for treatment of complex FP-ISR lesions, DCB angioplasty combined with laser atherectomy is associated with significantly reduced 1-year TLR and reocclusion rates
%K atherectomy
%K balloon angioplasty
%K drug-coated balloons
%K femoropopliteal disease
%K in-stent restenosis
%K laser atherectomy
%K peripheral artery disease
%K popliteal artery
%K reocclusion
%K superficial femoral artery
%K target lesion revascularization
%U https://journals.sagepub.com/doi/full/10.1177/1526602817745668