Drug-coated balloon (DCB) therapy is a viable and effective treatment for femoropopliteal artery disease in patients undergoing hemodialysis (HD), according to a new study. The multicenter prospective POPCORN study that includes nearly 1,000 lesions in HD patients revealed that DCB therapy maintained strong patency rates at both 1 and 3 years. After propensity score matching, freedom from restenosis was 82.2% at one year and 61.9% at three years. In non-HD patients freedom from restenosis at one year was 85.8% and 66.3% at three years. “These findings provide reassurance that DCB endovascular therapy is a reasonable treatment for femoropopliteal lesions in patients on hemodialysis,” wrote the authors. The paper was published in the July 14 issue of JACC: Cardiovascular Interventions. “We observed acceptable long-term outcomes, especially given the complexity of disease in this population.” Patency rates Led by Yasutaka Yamauchi, MD, PhD, from the Takatsu General Hospital in Kawasaki, Japan, the study also highlighted the one year primary patency rate of 80.4% and the three year rate of 62.8%. The authors noted that these rates were much higher than the stenting results described in prior studies cited in the paper that reported poor patency rates for stents in HD patients with femoropopliteal artery disease. “Thus, DCB appears to be superior to stenting for femoropopliteal lesions in HD patients,” the authors concluded. The research team also revealed that complications such as vessel rupture and slow flow were rare, with perioperative complication rates comparable between HD and non-HD patients. “Poor below-the-knee runoff is a well-known risk factor for restenosis after femoropopliteal endovascular therapy,” the investigators noted. “When performing DCB-EVT, the presence or absence of distal lesions must be evaluated by angiography.” Study limitations Recognizing the study’s limitations, the researchers highlighted the exclusion of unsuccessful predilation cases and a lack of core lab adjudication. However, they also emphasized the significance of their findings for clinical practice. “This analysis showed reasonable 1- and 3-year outcomes for freedom from restenosis and target lesion revascularization.” “DCB-EVT is an acceptable routine treatment for femoropopliteal disease in patients with HD,” they added. In an accompanying editorial comment piece, Maxime Dubosq-Lebaz, MD, and Eric A. Secemsky, MD, from Harvard Medical School in Boston, praised the POPCORN study for shedding light on DCB therapy in HD patients with femoropopliteal disease. The experts wrote that while outcomes were modest compared to non-HD patients, the results were clinically meaningful. Outcome predictor “These results confirm that HD status remains a dominant predictor of adverse outcomes,” the editorialists commented. “However, the use of advanced endovascular therapies such as DCBs may narrow some of the differences in limb-related events.” The commentators also highlighted the biological challenges HD patients face stating that dialysis patients consistently experienced poorer outcomes after endovascular therapy. Drs Dubosq-Lebaz and Secemsky concluded by calling for more inclusive and tailored research, stating,“Although patency outcomes were lower than in the non-HD population, limb salvage remained high, and several predictors of failure were identified. These findings support the need for tailored endovascular strategies in HD patients.” Sources: Yamauchi Y, Takahara M, Soga Y, et al. Vessel Patency After Femoropopliteal Drug-Coated Balloon Therapy in Patients on Hemodialysis. JACC Cardiovasc. Interv. 2025;18:1660–1670. Dubosq-Lebaz M, Secemsky EA. Reviving Hope: The Impact of Drug-Coated Balloons in High-Risk PAD Patients on Hemodialysis. JACC Cardiovasc. Interv. 2025;18:1671–1674. Image Credit: Acronym – stock.adobe.com