Three-Year Sustained Clinical Efficacy of Drug-Coated Balloon Angioplasty in a Real-World Femoropopliteal Cohort
Authors: Torsello Giovanni , Stavroulakis Konstantinos , Brodmann Marianne , Micari Antonio , Tepe Gunnar , Veroux Pierfrancesco , Benko Andrew , Choi Donghoon , Vermassen Frank E. G. , Jaff Michael R. , Guo Jia , Dobranszki Reka , Zeller Thomas , Zeller Thomas , Torsello Giovanni , Tepe Gunnar , Peeters Patrick , Scheinert Dierk , Bosiers Marc , Maene Lieven , Micari Antonio , Do Dai-Do , Hendriks Jeroen , Keirse Koen , Brodmann Marianne , Merkely Bela , Lardenoije Jan-Willem , Ruzsa Zoltan , Vogel Britta , Veroux Pierfrancesco , Albuquerque e Castro Joao , Periard Daniel , Ludyga Tomasz , Midy Dominique , Choi Donghoon , Lansink Wouter , Ketelsen Dominik , Dubenec Steven , Banyai Martin , Chakfe Nabil , Xaver Roithinger Franz , Trani Carlo , Mansour Hossam , Rha Seung-Woon , Vermassen Frank , Belenky Alexander , Spak Lubomir , Chalmers Nicholas , Benko Andrew , Kum Steven , Won Je Hwan , Vozar Matej , Teng Tan Kong , Labib Mamdouh , Borst Gert-Jan de , Do Young-Soo , Teijink Joep , Gomez Juan Fernando , Falkowski Aleksander , Ferreira Luis , Matela Jozef , Lee Seung-Whan , Verhoeven Bart , Mannheim Dalit , Nessi Franco , Vulev Ivan , Vries Jean-Paul de , Maly Radovan , Kavteladze Zaza , Turner Douglas , Mendiz Oscar , Kolvenbach Ralf , Karnabatidis Dimitrios , Cuellar Cesar , Venermo Maarit , Velicka Linas , Lundberg Goran 
Published: June 2020

Purpose: To report the 36-month outcomes from the prospective, multicenter, single-arm IN.PACT Global Study ( ClinicalTrials.gov identifier NCT01609296) evaluating the performance of the IN.PACT Admiral drug-coated balloon (DCB) in real-world patients with femoropopliteal occlusive disease. Materials and Methods: The IN.PACT Global Study was conducted at 64 international sites and enrolled 1535 patients with complex lesions, which included bilateral disease, multiple lesions, de novo in-stent restenosis, long lesions, and chronic total occlusions. The predefined full clinical cohort included 1406 patients (mean age 68.6 years; 67.8% men) with claudication or rest pain treated with the study DCB. Mean lesion length was 12.09±9.54 cm; 18.0% had in-stent restenosis, 35.5% were totally occluded, and 68.7% were calcified. Freedom from clinically-driven target lesion revascularization (CD-TLR) was evaluated through 36 months. The safety composite endpoint was freedom from device- and procedure-related death through 30 days and freedom from major target limb amputation and clinically-driven target vessel revascularization within 36 months. All safety and revascularization events were reviewed by an independent clinical events committee. Results: The Kaplan-Meier estimate of freedom from CD-TLR through 36 months was 76.9%. The composite safety endpoint was achieved in 75.6% of patients. The 36-month all-cause mortality rate was 11.6%, and the major target limb amputation rate was 1.0%. The Kaplan-Meier estimate of freedom from CD-TLR through 36 months was significantly lower in patients with chronic limb-threatening ischemia (CLTI) compared with claudicants (67.6% vs 78.0%; p=0.003). Lesions affecting both the superficial femoral artery (SFA) and popliteal artery had lower Kaplan-Meier freedom from CD-TLR through 36 months (69.2%) than either isolated SFA (79.7%) or popliteal artery lesions (76.5%; log- rank p<0.001). Predictors of CD-TLR through 36 months included increased lesion length, reference vessel diameter ≤4.5 mm, in-stent restenosis, bilateral disease, CLTI, and hyperlipidemia. Conclusion: DCB angioplasty with the IN.PACT Admiral DCB for femoropopliteal disease in a diverse and complex real-world population is associated with sustained clinical efficacy and low rates of reinterventions at 3 years after the initial procedure.