Plain uncoated balloon versus drug-coated balloon in the management of in-stent restenosis of femoropopliteal lesions: a comparative study of the effect of lesion length on the outcome

Aim
To compare the effectiveness of plain balloon and drug-coated balloon (DCB) in the management of in-stent restenosis (ISR) of femoropopliteal lesions regarding reocclusion rate and target lesion revascularization (TLR).
Patients and methods
A retrospective study was carried out on 31 patents complaining of critical limb ischemia, Rutherford categories 4 or 5, due to femoropopliteal ISR during the period from June 2018 to June 2020 at Sohag University Hospitals and 6 October Insurance Hospital, Cairo. Patients were managed by one of two different modalities: group A, where patients were managed by DCB, and group B, where patients were managed by plain balloon. In each group, according to the lesion length of the ISR, patients were classified into long lesions (>10 cm) and short lesions (<10 cm). Recurrent occlusion and TLR were evaluated and compared between the two groups.
Results
Group A consisted of 19 patients, with 11 long lesions and eight short lesions, whereas group B consisted of 12 patients, with five long lesions and seven short lesions. In short lesions, reocclusion was recorded in 12.5% (1/8 patients) of the DCB group compared with 57.1% (4/7 patients) in the plain balloon group (≤0.001), whereas in long lesions, the reocclusion was recorded in 36.4% (4/11 patients) of the DCB group compared with 60% (3/5 patients) (=0.65). TLR was recorded in two patients of plain balloon group, whereas no cases were reported in the DCB group in short lesions, whereas in long lesions, four cases developed TLR [two (18.2%) cases of DCB group and two (40%) cases of plain balloon group). Regarding TLR results, the performance of DCB in ISR differs significantly in short lesions compared with long lesions (≤0.05).
Conclusion
DCB angioplasty offers an effective outcome in the management of femoropopliteal ISR, especially in short lesions. However, in long lesions, it yields higher but insignificant results compared with plain balloon angioplasty. Long-term results of management of ISR in long lesions are awaited irrespective of the technology used.