Atherectomy and Intravascular Lithotripsy Provide Comparable Outcomes for Common Femoral Artery Atherosclerotic Disease: A Systematic Review With Meta-analysis

OBJECTIVE: To identify, synthesize, and critically appraise the published studies reporting outcomes of atherectomy and/or intravascular lithotripsy (IVL) for symptomatic common femoral artery (CFA) atherosclerosis and therefore provide support in clinical decision-making. DESIGN: Systematic review with meta-analysis. DATA SOURCES AND REVIEW METHODS: This review was registered in PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A search was performed on MEDLINE and Embase. Inclusion criteria were prospective or retrospective comparative or non-comparative studies and research letters, published between Jan 01, 2000 and Dec 01, 2023, written in English or French, that reported on adults with symptomatic atherosclerotic stenosis or occlusion, localized within the CFA, treated with atherectomy and/or IVL. Study and lesion characteristics, clinical and technical outcomes were extracted independently by 2 reviewers, and data were pooled for 5 selected outcomes. Risk of bias was assessed with Mixed Methods Appraisal Tool (MMAT). RESULTS: Sixteen studies (13 on atherectomy, 960 limbs; 3 on IVL, 66 limbs) were included. Both atherectomy and IVL had good outcomes in terms of technical success (96% vs 97%), proportion of bailout stenting (6% vs 8%), freedom from target lesion revascularization (TLR; 90% vs 91%), and limb salvage (97% vs 95%). IVL tended to have more perioperative complications than atherectomy (16% vs 10%). Five studies on atherectomy and 2 studies on IVL met all 7 MMAT criteria, 4 studies on atherectomy met 6 criteria, while 4 studies on atherectomy and 1 study on IVL met 4 or 5 criteria. CONCLUSION: Atherectomy and IVL can have equally good short- to mid-term outcomes for the treatment of symptomatic CFA atherosclerosis in terms of technical success, as well as freedom from TLR and limb salvage. Although these findings suggest that the choice between atherectomy and IVL for CFA atherosclerosis can be at the discretion of the clinician, further studies with longer follow-up are needed to formulate clinical recommendations.Clinical ImpactThis systematic review with meta-analysis can help clinicians to make evidence-based choices between endovascular treatments for common femoral artery (CFA) atherosclerosis. It shows that atherectomy and intravascular lithotripsy (IVL) have equally good short- to mid-term outcomes in treating CFA atherosclerosis, both in terms of technical success, as well as limb salvage and freedom from target lesion revascularization. These findings suggest that the choice between atherectomy and IVL for CFA atherosclerosis can be at the discretion of the clinician, however, further studies with longer follow-up are needed to formulate clinical recommendations.