Rotational Atherectomy-Assisted Balloon Angioplasty versus Plain Balloon Angioplasty for Infrapopliteal Lesions in Chronic Limb-Threatening Ischemia: A Retrospective Observational Study
Haluk Çaglar Karakaya1,2
, Tanzer Tokatlıoğlu3
1Department of Cardiovascular Surgery, Üsküdar University Faculty of Medicine, İstanbul, Türkiye
2Department of Cardiovascular Surgery, Beykoz State Hospital, İstanbul, Türkiye
3Department of Cardiovascular Surgery, University of Health Sciences, Sancaktepe Şehit Prof. Dr. İlhan Varank Research and Training Hospital, İstanbul, Türkiye
Keywords: Angioplasty; balloon atherectomy; chronic limb-threatening ischemia; endovascular procedures; peripheral arterial disease.
Abstract
Objective: This study aimed to compare procedural and mid-term clinical outcomes between rotational atherectomy-assisted balloon angioplasty (RA+POBA) and POBA alone for infrapopliteal (IP) lesions in patients with chronic limb-threatening ischemia (CLTI).
Methods: This retrospective study included 71 consecutive patients with CLTI who underwent endovascular intervention for IP peripheral arterial disease between January 2020 and January 2025 and had at least 6 months of follow-up. A total of 78 limbs were analyzed and categorized into RA+POBA and POBA groups. The primary outcome was target lesion revascularization (TLR) during follow-up. Limb-level outcomes were analyzed accounting for within-patient clustering.
Results: Patient-level analysis included 35 patients in the RA+POBA group and 36 patients in the POBA group. Follow-up duration was similar between groups (18.0 [12–63] vs. 21.0 [12–82] months; p=0.919). TLR occurred in 6 limbs in both groups (15.4% vs. 15.4%; risk ratio [RR] 1.15, 95% confidence interval [CI] 0.23–5.66; p=0.866). Major amputation occurred in 1 limb in the RA+POBA group and 9 limbs in the POBA group (2.6% vs. 23.1%; RR 0.12, 95% CI 0.02–0.81; p=0.030). No significant differences were observed in minor amputation or all-cause mortality.
Conclusion: In this retrospective cohort, RA+POBA was associated with a lower major amputation rate. However, this secondary, unadjusted finding was based on a limited number of events and should be considered hypothesis-generating. Furthermore, the absence of differences in TLR and mortality suggests that these findings should not be interpreted as evidence of superior patency, durability, or survival benefit.
Cite This Article: Karakaya HÇ, Tokatlıoğlu T. Rotational AtherectomyAssisted Balloon Angioplasty versus Plain Balloon Angioplasty for Infrapopliteal Lesions in Chronic Limb-Threatening Ischemia: A Retrospective Observational Study. Koşuyolu Heart J 2026;29(3):203–211