Factors in Sufficient Endovascular Vessel Preparation for Severely Calcified Femoropopliteal Lesions

Abstract

Study ParticipantsThis was a single-center retrospective observational study conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Kansai Rosai Hospital (reference no. 19 16D008g). From July 2012 to April 2021, intravascular ultrasound (IVUS)-supported EVT under a provisional stenting strategy was performed for 955 de novo FP lesions in 773 patients with symptomatic LEAD. Of them, 849 lesions were excluded for the following reasons: (1) no calcification (n=275); (2) not total circumferential calcification (n=499); (3) lack of IVUS data after preballoon dilatation (n=72); and (4) lack of postprocedural IVUS data (n=3). The remaining 106 de novo FP lesions in 97 patients were analyzed in this study. The study flowchart is shown in Figure 1. Because this was an noninvasive observational study without intervention Approximately half of all symptomatic patients with lower extremity arterial disease (LEAD) have femoropopliteal (FP) lesions, 1 with half of such cases complicated by vessel calcification (2). The presence of vessel calcification affects the occurrence of restenosis after endovascular therapy (EVT) with stents, 2-4 mainly due to insufficient dilation and consequent recoil during the initial treatment. 3,4 Although atherectomy devices can effectively treat severely calcified FP lesions, they are not routinely used in contemporary FP practice because of their high cost, risk of complications including distal embolization, and insufficient results of combined use. 5-7 Although the importance of vessel preparation was recently reported, 8,9 the factors contributing to sufficient vessel preparation for severely calcified FP lesions have not been elucidated, which became the aim of our study.