A Registry-based Study of Paclitaxel Drug-coated Balloon Angioplasty for the Treatment of In-stent Restenosis of the Femoral-popliteal Artery

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Journal of vascular surgery


OBJECTIVE: To report the results of a prospective, single-arm, registry-based study assessing the safety and performance of a paclitaxel drug-coated balloon (DCB) for the treatment of superficial femoral artery (SFA) or popliteal artery in-stent restenosis (ISR) in a United States population. METHODS: We conducted a prospective, non-randomized, multi-center, single-arm, post-market registry of the IN.PACT Admiral DCB for the treatment of ISR lesions in the SFA or popliteal artery at 43 sites within the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) Registry from December 2016 to January 2020. Clinical outcomes were assessed at 12-, 24-, and 36- months. The primary endpoint was target lesion revascularization (TLR) at 12-months. Secondary endpoints included technical success, target vessel revascularization (TVR), major limb amputation, and all-cause mortality. Results are presented as survival probabilities based on Kaplan-Meier survival estimates. RESULTS: Patients (N=300) were 58% male with a mean age of 68 ± 10 years. Diabetes was present in 56%, 80% presented with claudication and 20% with rest pain. Lesions included ISR of the SFA in 68%, SFA-popliteal in 26%, and popliteal arteries in 7%. The mean lesion length was 17.8 ± 11.8 cm. Lesions were categorized as occlusions in 43% (mean occluded length 16 ± 10 cm). TASC type was A (17%), B (29%), C (38%), and D (15%). Technical success was 99%. Re-stenting was performed in 5% and thrombolysis in 0.6% of patients. Kaplan-Meier estimates for freedom from TLR were 90%, 72% and 62% at 12-, 24- and 36 months. Freedom from TVR was 88%, 68% and 59% and freedom from major target limb amputation was 99%, respectively, at 12-, 24 and 36-months. Survival was 95%, 89% and 85% at 12-, 24- and 36-months. CONCLUSION: This post-market registry-based study shows promising results in treating femoral-popliteal ISR with paclitaxel DCB in comparison to the results of plain balloon angioplasty reported in the literature. These results demonstrate the ability of the SVS VQI to conduct post-market evaluation of peripheral devices in partnership with industry and federal regulators.