Norihiko Kamioka1, Yoshimitsu Soga1, Shoichi Kuramitsu1, Osamu Iida2, Keisuke Hirano3, Kenji Suzuki4, Daizo Kawasaki5, Terutoshi Yamaoka6, Nobuhiro Suematsu7, Yoshiaki Shintani8, Yusuke Miyashita9, Hiroki Takahashi10, Taketsugu Tsuchiya11, Norihiko Shinozaki12, Shinya Okazaki13, Kenji Ando1. 1. Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan. 2. Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan. 3. Department of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama, Japan. 4. Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan. 5. Cardiovascular Division, Hyogo College of Medicine, Nishinomiya, Japan. 6. Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan. 7. Department of Cardiology, Fukuoka Red Cross Hospital, Fukuoka, Japan. 8. Department of Cardiology, Shin-Koga Hospital, Kurume, Japan. 9. Department of Advanced PAD Therapeutics, Shinshu University, Matsumoto, Japan. 10. Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine, Yamagata, Japan. 11. Division of Trans-Catheter Cardiovascular Therapeutics, Kanazawa Medical University Hospital, Ishikawa, Japan. 12. Department of Cardiology, Tokai University Hospital, Isehara, Japan. 13. Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan.
Abstract
OBJECTIVES: We sought to assess whether balloon angioplasty (BA) alone for small femoropopliteal disease improved the outcome following endovascular therapy as compared with stent implantation. BACKGROUND: The optimal strategy of endovascular therapy for small vessel arteries in femoropopliteal disease remains unclear. METHODS: We performed a multicenter retrospective analysis of 337 consecutive patients (371 limbs) with femoropopliteal arteries 4.0 mm or less in diameter and 150 mm or less in length. RESULTS: Cumulative 3-year incidence of primary patency was significantly higher in the BA group than in the stent group (53.8% vs. 34.2%, P = 0.002). While assisted-primary patency and freedom from any major adverse limb events were also significantly higher in the BA group than in the stent group (70.9% vs. 44.2%, P < 0.001 and 60.6% vs. 36.4%, P = 0.001, respectively), secondary patency did not significantly differ between the two groups (86.9% vs. 86.9%, P = 0.67). Predictors of restenosis were diabetes mellitus (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.14-2.31; P = 0.01), no administration of cilostazol (HR, 1.50; 95% CI, 1.07-2.13; P = 0.02), stent implantation (HR, 1.68; 95% CI, 1.15-2.41; P = 0.01), and lesion length >75.0 mm(HR, 2.09; 95% CI, 1.50-2.92; P < 0.001). CONCLUSIONS: Lesions in small (<4.0 mm diameter) FP vessels demonstrated better primary patency at 3 years when successfully treated with balloon angioplasty alone as opposed to routine or bailout stenting. This difference was especially pronounced for lesions 75 to 150 mm in length.
OBJECTIVES: We sought to assess whether balloon angioplasty (BA) alone for small femoropopliteal disease improved the outcome following endovascular therapy as compared with stent implantation. BACKGROUND: The optimal strategy of endovascular therapy for small vessel arteries in femoropopliteal disease remains unclear. METHODS: We performed a multicenter retrospective analysis of 337 consecutive patients (371 limbs) with femoropopliteal arteries 4.0 mm or less in diameter and 150 mm or less in length. RESULTS: Cumulative 3-year incidence of primary patency was significantly higher in the BA group than in the stent group (53.8% vs. 34.2%, P = 0.002). While assisted-primary patency and freedom from any major adverse limb events were also significantly higher in the BA group than in the stent group (70.9% vs. 44.2%, P < 0.001 and 60.6% vs. 36.4%, P = 0.001, respectively), secondary patency did not significantly differ between the two groups (86.9% vs. 86.9%, P = 0.67). Predictors of restenosis were diabetes mellitus (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.14-2.31; P = 0.01), no administration of cilostazol (HR, 1.50; 95% CI, 1.07-2.13; P = 0.02), stent implantation (HR, 1.68; 95% CI, 1.15-2.41; P = 0.01), and lesion length >75.0 mm(HR, 2.09; 95% CI, 1.50-2.92; P < 0.001). CONCLUSIONS: Lesions in small (<4.0 mm diameter) FP vessels demonstrated better primary patency at 3 years when successfully treated with balloon angioplasty alone as opposed to routine or bailout stenting. This difference was especially pronounced for lesions 75 to 150 mm in length.