ObjectiveTo identify risk factors for severe elastic recoil after percutaneous transluminal angioplasty (PTA) in the femoropopliteal artery disease based on intravascular ultrasound (IVUS) imaging and to develop a risk prediction model. MethodsA retrospective analysis was conducted on the clinical data from the patients with femoropopliteal artery disease treated at the First Affiliated Hospital of Chongqing Medical University from September 2020 to February 2022. Based on the IVUS images, a multivariate logistic regression analysis was conducted to identify the risk factors for severe elastic recoil in the patients with femoropopliteal artery disease after PTA. A nomogram prediction model was established to predict the occurrence of severe elastic recoil, and the area under receiver operating characteristic curve (AUC) was used to evaluate its ability to distinguish the occurrence of severe elastic recoil, which was validated using a calibration curve. ResultsA total of 34 patients with femoropopliteal artery disease who received PTA treatment were enrolled. Of the 803 vessel slices were analyzed, 451 (56.16%) demonstrated severe elastic recoil on IVUS imaging. The multivariate logistic regression analysis showed that the increased plaque burden, luminal eccentric index, external elastic membrane remodeling index, and the external elastic membrane-balloon area ratio were the risk factors for the occurrence of severe elastic recoil (P＜0.05). The AUC of the nomogram prediction model based on these risk factors exhibited moderate discrimination [AUC (95%CI)=0.775 (0.732, 0.818)]. The predicted probability of the nomogram model for severe elastic recoil was in a good agreement with the actual probability (P=0.862). ConclusionThe severe elastic recoil prediction model developed in this study, based on IVUS imaging data, can effectively identify high-risk factors for severe elastic recoil after PTA in patients with femoropopliteal artery disease, demonstrating a moderate predictive discrimination capability.
ObjectiveTo evaluate the clinical efficacy and safety of directional atherectomy (DA) combined with drug-coated balloon (DCB) for the treatment of femoropopliteal artery lesions. MethodsA retrospective analysis was performed on data from patients with femoropopliteal artery lesions treated with DA combined with paclitaxel DCB from January 2021 to November 2022 in the TALENT study (NCT04675632). Observational metrics included intraoperative bailout stenting rate, maximum DCB diameter, 12-month freedom from clinically-driven target limb revascularization (CD-TLR), incidence of major adverse events (MAEs), and changes in Rutherford category and vascular-related quality of life score. ResultsThis study enrolled 189 limbs from 184 patients. The age was (71.0±9.4) years, and 69.0% (127/184) were male. Comorbidities were common, including diabetes mellitus [71.2% (131/184)] and coronary artery disease [34.2% ( 63/184)], with 32.6% (60/184) having a history of smoking. The lesions had a length of (181.2±119.6) mm, with chronic total occlusion accounting for 63.0% (119/189). In terms of clinical severity, 47.1% (89/189) were classified as Rutherford category 3, and 52.9% (100/189) presented with chronic limb-threatening ischemia (Rutherford categories 4–6). According to Trans-Atlantic Inter-Society Consensus Ⅱ classification, 52.9% (100/189) were type A+B, and 47.1% (89/189) were type C+D; 18.0%(34/189) of the lesions exhibited severe calcification. The technical success rate of DA combined with DCB treatment was 96.8%(183/189), with a bailout stent implantation rate of 4.2% (8/189). The maximum DCB diameter used was (5.1±0.6) mm. At the 12-month follow-up, the cumulative freedom from CD-TLR rate was 96.1% [95%CI (92.6%, 98.2%)], and the cumulative freedom from MAEs rate was 89.2% [95%CI (84.0%, 92.9%)]. Both the postoperative Rutherford category and quality of life score showed significant improvement compared to baseline [1.81±1.39 versus 3.89±1.22, MD (95%CI)=?2.08 (?2.29, ?1.87), P<0.001; (5.51±1.09) points versus (2.90±1.05) points, MD (95%CI)=2.61 (2.46, 2.76), P<0.001]. ConclusionDA combined with paclitaxel DCB for the treatment of femoropopliteal artery lesions effectively achieves lumen enlargement, reduces the need for intraoperative bailout stenting, and demonstrates favorable 12-month clinical outcomes, representing a feasible vessel preparation strategy.