Debulking Before Drug-Coated Balloon Reduces Amputation and TLR in Femoropopliteal In-Stent Restenosis

Meta-analysis (n=584): debulking + drug-coated balloon vs. balloon alone for femoropopliteal in-stent restenosis reduced 12-month TLR (RR 0.58, 95% CI 0.38–0.88) and amputation (RR 0.37, 95% CI 0.18–0.75); greatest benefit in long or occlusive lesions.

• Systematic review and meta-analysis of 7 studies (3 RCTs, 4 retrospective cohorts); 281 patients received debulking + DCB vs. 303 DCB alone — overall primary patency rates at 6 and 12 months did not differ between groups.
• Subgroup of long lesions (>20 cm) or Tosaka type III occlusions showed improved 12-month primary patency (RR 1.66, 95% CI 1.19–2.34, P=0.003) and markedly reduced TLR (RR 0.35, 95% CI 0.18–0.69, P=0.002) with combined treatment.
• Key limitation: only 7 heterogeneous studies (mix of RCTs and retrospective designs) with a total of 584 patients; authors caution that advantages require confirmation in larger, prospective trials.

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