Bypass Surgery vs. Drug-Eluting Stent for Trans-Atlantic Inter-Society Consensus-II (TASCII) C or D Femoropopliteal Lesions.

Background: Bypass surgery (BSX) as first-line therapy for Trans-Atlantic Inter-Society Consensus-II (TASCII) C/D femoropopliteal (FP) lesions is recommended. Recent reports have shown that a drug-eluting stent (DES) provides good durability up to the mid-term. We investigated clinical outcomes after BSX vs. DES for TASCII C/D FP lesions.

Methods and results: As treatment of de novo TASCII C/D FP lesions, 274 patients who underwent DES implantation and 201 patients who had BSX were identified and analyzed. Each group had at least 1 year of follow-up data. The primary endpoint was binary restenosis. Secondary endpoints were major amputation, reintervention, reocclusion and major adverse limb event (MALE; including major amputation or any reintervention and restenosis). Before matching, the binary restenosis rate was significantly higher in the DES group than in the BSX group (42% vs. 18%, P<0.001). After propensity matching, the 1-year restenosis rate was still higher in the DES group (44% vs. 18%, P<0.001). The DES group also had a significantly higher incidence of reintervention and MALE. Major amputation and reocclusion showed no significant difference. The subsequent stratification analysis reconfirmed no significant interaction effect of any background characteristics on the association of DES implantation vs. BSX with the 1-year restenosis risk.

Conclusions: BSX is still a feasible and recommended treatment for TASCII C/D FP lesions in Japanese patients, based on good durability up to 1 year.