Association of Angiographic Dissections with Procedural Strategies and Patency After Drug Coated Balloon Angioplasty in the Superficial Femoral and Popliteal Arteries

Background:
To investigate the prevalence of angiographic dissections after vessel preparation of superficial femoral artery and popliteal artery disease and to evaluate the association of dissections with outcomes after of drug coated balloon angioplasty.

Methods:
A retrospective, single center analysis at a Veterans Administration Hospital, evaluating 375 cases with use of drug coated balloons between 2014 and 2018. The procedural approach in all cases was to perform pre-dilation followed by drug-coated balloon angioplasty. Bailout stenting was performed at the discretion of the operator. Baseline angiographic and procedural characteristics were identified. Vessel dissection after balloon angioplasty was characterized as A-F, using the modified NHLBI scoring system. After evaluating angiography identified 121 (32%) cases with dissections identified and treated with drug coated balloons without any stent placement. and 126 cases (33.6%) were excluded due to use of bailout stents in setting of dissections. Vessel dissection was graded into 7 types from A to F as previously described.

Results:
Among 375 cases, the baseline lesion length was 174 mm, the mean target vessel diameter was 5.65mm, and 42% (53/126) of lesions were heavily calcified. A dissection occurred in 86% of cases, with a mean dissection length of 75 mm and average amount of stent implanted 140 mm. Any dissection occurred in 86% of lesions. Among the 126 cases (33.6%) where a bailout stent was used, the post-angioplasty dissections were graded as graded as A in 2% of cases (2/126), Grade B 18 % (23/126), Grade C 35% (45/126) Grade D 17% (22/126), Grade E 17% (22/126), and Grade F 6% (7/126). In patients that had dissections that were treated with drug coated balloons and without stents, dissections were graded as A 51% (62/121), Grade B 33 % (40/121), Grade C 12% (14/121) Grade D 2% (3/121), Grade E 1.67% (2/121).

Conclusions:
Bailout stent placement was more common among cases where a severe dissection occurred, and in longer lesions. The association of final dissection severity with patency among patients treated with drug coated balloons will be presented at the meeting.