Auryon 355 nm Laser Atherectomy for Femoropopliteal In-Stent Occlusions: A Retrospective Comparative Study of Technical Success and 12-Month Outcomes

Background: Complete femoropopliteal in-stent occlusions remain technically challenging because durable treatment requires restoration of an intraluminal channel within the pre-existing stent scaffold. This study evaluated Auryon 355 nm laser-assisted recanalization compared with conventional endovascular recanalization in symptomatic patients with femoropopliteal in-stent occlusions. Methods: This retrospective single-center comparative study included patients treated with Auryon laser-assisted recanalization between May 2023 and June 2024 and a historical control group treated with conventional recanalization between January 2020 and April 2022. The prespecified primary endpoint was a conditional endpoint of 12-month primary patency among primary-strategy technically successful procedures. An exploratory full-cohort strategy-level analysis of 12-month durable technical success was also performed to account for initial technical failures. Results: Forty-four patients were analyzed: 18 in the Auryon group and 26 in the control group. Baseline clinical characteristics were broadly comparable, although selected anatomical and clinical imbalances were present. Post hoc sensitivity analyses were considered hypothesis-generating because of sparse events and wide confidence intervals. Primary-strategy technical success was significantly higher with Auryon-assisted recanalization than with conventional recanalization (94.4% vs. 65.4%, p = 0.031). In the conventional group, six of nine primary-strategy failures were subsequently recanalized after distal retrograde bailout puncture, yielding a descriptive final assisted recanalization rate of 88.5% (23/26). In the full-cohort strategy-level analysis, 12-month durable technical success was achieved in 83.3% of patients in the Auryon group and 50.0% in the control group (p = 0.030). Among primary-strategy technically successful procedures, 12-month primary patency was numerically higher after Auryon-assisted treatment (88.2% vs. 76.5%; log-rank p = 0.37), without statistically significant differences in patency-related secondary outcomes. No distal embolization or procedure-related complication occurred in the Auryon group. Conclusions: In this retrospective comparative experience, Auryon 355 nm laser atherectomy was associated with significantly higher primary-strategy technical success than conventional endovascular recanalization. Among successfully recanalized patients, 12-month patency-related outcomes were numerically favorable but not statistically significant. Larger prospective studies are warranted.