162 - Does DCB Work After IVL on Calcified Lesions? A Retrospective Study

Purpose: Intravascular lithotripsy (IVL) has shown promise in treating heavily calcified peripheral arterial lesions that are often resistant to conventional therapies. IVL is commonly used to prepare vessels for downstream treatments such as drug-coated balloon (DCB) angioplasty or stenting. However, the additive benefit of DCB following IVL remains unclear, especially given uncertainty over whether antiproliferative drugs can effectively diffuse through calcified plaque. In this study, we aimed to evaluate whether DCB therapy offers any advantage when used after IVL.

Materials and Methods: We conducted a retrospective cohort study of patients with peripheral arterial disease (PAD) undergoing femoropopliteal interventions using IVL followed by either DCB angioplasty (DCB group) or IVL with or without plain balloon angioplasty (control group). All patients had moderate-to-severe calcified lesions and at least one year of follow-up. Primary outcomes were freedom from restenosis at 1 year, need for reintervention, and change in ankle-brachial index (ABI). Secondary outcomes included overall survival, functional status, ambulation status, and freedom from major amputation. Demographics, comorbidities, and procedural details were collected and used for regression analysis.

Results: A total of 31 patients met inclusion criteria: 19 in the IVL+DCB group and 12 in the control group. At one year, there was no statistically significant difference in restenosis rates between the groups (36% for control and 26% for DCB) (p = 0.690). Similarly, no significant difference was observed in ABI improvement (p = 0.805). The relative risk of amputation at 18 months was 0.58 (DCB vs. control; p = 0.387), indicating a nonsignificant trend toward lower risk in the DCB group.

Conclusion: In this retrospective analysis, no significant differences in treatment outcomes were observed at one year between patients treated with IVL+DCB versus IVL with or without POBA. These findings suggest limited short-term benefit of DCB in heavily calcified femoropopliteal lesions following IVL. It remains possible that severe arterial calcification impairs drug uptake and reduces the efficacy of DCBs in this setting. Larger studies with longer-term follow-up are needed.