Cardiovasc Intervent Radiol. 2026 Mar 1. doi: 10.1007/s00270-026-04393-8. Online ahead of print.
ABSTRACT
PURPOSE: To compare endovascular strategies for femoropopliteal lesions extending to the distal popliteal artery (PA).
MATERIALS AND METHODS: We retrospectively analyzed 275 femoropopliteal lesions extending to the distal PA (P2/P3) treated with drug-coated balloons (DCBs) and/or stents between July 2011 and October 2021. Outcomes were compared among three treatment strategies: full-cover stent (n = 90), full-cover DCB (n = 128), and hybrid therapy (n = 57) defined as stent implantation within P1 combined with DCB treatment in P2/P3. The primary outcomes were restenosis and major adverse limb events (MALE). Adjusted analyses using inverse probability of treatment weighing (IPTW) were performed to account for background differences. Predictors of restenosis were evaluated using Cox proportional hazards models.
RESULTS: The 24-month restenosis rate was lowest with hybrid therapy compared to full-cover stent and full-cover DCB (26.7% vs. 62.1% vs. 60.7%, P = 0.010), whereas the 24-month MALE rate was highest with full-cover stent (29.1% vs.13.6% vs. 12.2%, P = 0.002) with the consistent findings after IPTW. Multivariate analysis identified full-cover DCB, full-cover stent, (hazard ratio [HR]: 1.95 and 2.42, P = 0.039 and 0.009 compared with hybrid therapy) and involving distal popliteal chronic total occlusion (HR: 1.70, P = 0.049) were independent predictors of restenosis, whereas hypertension (HR: 0.63, P = 0.025) was associated with reduced risk. Notably, restenosis after hybrid therapy was predominantly occlusive.
CONCLUSION: Hybrid therapy for femoropopliteal lesions extending to the distal PA was associated with lower restenosis rate without increasing MALE risk. However, occlusive restenosis may complicate repeat intervention and warrants careful surveillance. Findings should be interpreted in light of treatment-selection bias and device heterogeneity.
PMID:41764105 | DOI:10.1007/s00270-026-04393-8