Full-Coverage Drug-Eluting Stent Vs Drug-Coated Balloon in De Novo Femoropopliteal Lesions: Three-Year TASC II-Stratified Outcomes

BACKGROUND: Paclitaxel-based devices improve femoropopliteal outcomes; however, the optimal strategy for de novo lesions by lesion complexity remains uncertain. This study compared long-term outcomes of full-coverage drug-eluting stent (DES) implantation and drug-coated balloon (DCB) angioplasty stratified by the Trans-Atlantic Inter-Society Consensus II (TASC II) classification. METHODS: This retrospective, single-center study included 419 patients (507 limbs) with de novo femoropopliteal lesions treated between 2019 and 2021. Limbs were stratified into TASC II A/B (186 limbs) and C/D (321 limbs) groups and treated with DES (107 limbs) or DCB (400 limbs). The primary endpoint was 3-year primary patency, defined as freedom from target lesion revascularization (TLR) or duplex ultrasound-detected restenosis (peak systolic velocity ratio ≥2.5). Secondary endpoints included 3-year freedom from TLR and amputation-free survival (AFS). RESULTS: In TASC II A/B lesions, 3-year primary patency was comparable between DES and DCB (80.0% vs 76.9%, p=0.432), as were freedom from TLR (84.2% vs. 88.0%, p=0.959) and AFS (74.3% vs 78.3%, p=0.834). In TASC II C/D lesions, DES achieved higher 3-year primary patency (85.1% vs 50.3%, p