Drug-Coated Balloons for Long Superficial Femoral Artery Disease: Leaving Nothing Behind in the Real-World.

SEE PAGE 950 T he optimal endovascular strategy for treatment of superficial femoral artery (SFA) atherosclerotic disease is an evolving area of research and clinical practice. Initial randomized trials demonstrated a benefit of nitinol self-expanding stent placement in this region when compared to standalone balloon angioplasty (1). However, observational studies subsequently raised concerns regarding the risk of stent fracture and significant restenosis due to the unique mechanical forces in the SFA and popliteal artery (2). Further refinements in stent technology have resulted in lower rates of stent fracture, but most currently available nitinol stent platforms continue to demonstrate a linear relationship between stent length and restenosis (3). The longer lesion lengths frequently encountered in clinical practice may thus be susceptible to lower long-term patency with multiple overlapping nitinol stents. The development of paclitaxel-based drug-eluting stents (DES) anddrug-coated balloons (DCB) represents an evolution in the endovascular treatment of peripheral artery disease. Paclitaxel-eluting nitinol stents have been shown to be superior to both balloon angioplasty and primary nitinol stenting, with outcomes data nowavailable up to 5 years (4). Recent randomized clinical trials have also demonstrated that angioplasty with a DCB is superior to standard balloon angioplasty for moderate length lesions in the femoropopliteal region (5,6). Although direct comparative effectiveness studies have not been performed, these results suggest