What ’ s Next in Drug - Eluting SFA

VOL. 16, NO. 9 SEPTEMBER 2017 ENDOVASCULAR TODAY 73 How would you characterize the current state of drug-delivery devices available for use in the superficial femoral artery (SFA)? Our first experience with drug-delivery platforms was in the coronary arteries, where the success with drug-eluting stents (DESs) has been so significant that it is unlikely the market will revert to favoring non–drug-eluting solutions. The improved patency and clinical outcomes observed with local drug delivery ushered in a new era in the superficial femoral and popliteal segments as well, although bare devices continue to have a role. The SFA also poses unique challenges related to biomechanical forces and lesion length and composition. Whereas stenting still dominates coronary intervention, the desire to leave nothing behind is often a deciding factor in SFA device selection, creating a substantial role for drug-coated balloons (DCBs). However, one potential downside of a balloon-only approach is that depending on the complexity of the disease, a percentage of these patients will cross over to stent placement as well. Some interventionalists will elect for a DES in these cases, feeling that why not place a stent as a primary strategy if they will likely need to place one anyway. Similarly, the disadvantages of implantable devices become apparent if they fail, at which point the next therapeutic options are limited due to the permanent implant being in place. The bottom line is that both types of devices have shown improved performance over their bare counterparts in clinical trials in both safety and efficacy. The decision as to which to choose is up to the operator based on the patient and lesion characteristics.