<h2 class="section-title u-h3 u-margin-l-top u-margin-xs-bottom">Abstract</h2> <div id="as0005"> <h3 class="u-h4 u-margin-m-top u-margin-xs-bottom" id="st0010">Background</h3> <p id="sp0055"><span>Infrapopliteal (IP) lesions are common in patients with<span> </span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/critical-limb-ischemia" title="Learn more about critical limb ischemia from ScienceDirect's AI-generated Topic Pages">critical limb ischemia</a><span> </span>(CLI). Optimal<span> </span></span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/revascularization" title="Learn more about revascularization from ScienceDirect's AI-generated Topic Pages">revascularization</a><span><span> </span>strategies including the use of adjunctive<span> </span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/atherectomy" title="Learn more about atherectomy from ScienceDirect's AI-generated Topic Pages">atherectomy</a><span> </span>have the potential to improve the outcomes for these patients.</span></p> </div> <div id="as0010"> <h3 class="u-h4 u-margin-m-top u-margin-xs-bottom" id="st0015">Objective</h3> <p id="sp0060">To compare laser<span> </span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/atherectomy" title="Learn more about atherectomy from ScienceDirect's AI-generated Topic Pages">atherectomy</a><span> </span>(LA) vs. balloon angioplasty alone for the treatment of IP lesions in patients with CLI.</p> </div> <div id="as0015"> <h3 class="u-h4 u-margin-m-top u-margin-xs-bottom" id="st0020">Methods</h3> <p id="sp0065">This was a two-center retrospective study of patients with CLI who underwent endovascular interventions for IP lesions. One and 2-year<span> </span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/target-lesion-revascularization" title="Learn more about target lesion revascularization from ScienceDirect's AI-generated Topic Pages">target lesion revascularization</a><span><span><span> </span>(TLR) was the primary outcome. One and 2-year limb loss and major adverse limb events (MALE) were secondary outcomes.<span> </span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/propensity-score-matching" title="Learn more about Propensity score matching from ScienceDirect's AI-generated Topic Pages">Propensity score matching</a><span> </span>was performed. A<span> </span></span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/proportional-hazards-model" title="Learn more about Cox regression from ScienceDirect's AI-generated Topic Pages">Cox regression</a><span><span> </span>analysis was used to compare 1- and 2-year outcomes of the two groups.<span> </span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/logistic-regression-analysis" title="Learn more about Logistic regression analysis from ScienceDirect's AI-generated Topic Pages">Logistic regression analysis</a><span> </span>was used to compare the two groups in terms of bail-out stenting and procedural complications.</span></span></p> </div> <div id="as0020"> <h3 class="u-h4 u-margin-m-top u-margin-xs-bottom" id="st0025">Results</h3> <p id="sp0070">A total of 313 patients with CLI were included; 76 were treated with LA. There was a high degree of lesion complexity in both groups. Consistent with the application of LA in the most complex lesions, lesions in the LA group were significantly longer (165.7 mm vs. 94.1 mm; p < 0.001) and were more frequently TASC C/D (82% vs. 45%; p < 0.001). In-stent restenosis (ISR) lesions were also more common among the LA group (14% vs. 0.4%; p < 0.001). Thrombotic lesions were present in 11% of the LA group vs. 4% in the no LA group (p = 0.04). CTOs were also more common in the LA group (58% vs. 43%; p = 0.024). After propensity matching, there was no difference in the 1 or 2-year TLR rates between the two groups. Similarly, there were no differences between the two groups in terms of 1 or 2-year limb loss or 2-year major adverse limb events.</p> </div> <div id="as0025"> <h3 class="u-h4 u-margin-m-top u-margin-xs-bottom" id="st0030">Conclusions</h3> <p id="sp0075">LA is safe and effective for IP lesions in patients with CLI. There was a higher baseline angiographic complexity in patients treated with LA, suggesting that operators tend to use LA for the treatment of more complicated lesions. There was no difference among the two groups in 1- or 2-year outcomes of TLR of major amputation.</p> </div>