Khung-Keong Yeo1, Umer Malik, John R Laird. 1. Division of Cardiovascular Medicine and The Vascular Center, University of California, Davis Medical Center, Sacramento, California, USA.
Abstract
OBJECTIVES: The aim of this study is to describe a single-center experience with endovascular treatment of femoropopliteal in-stent restenosis (ISR). BACKGROUND: Femoropopliteal artery stenting is associated with a significant risk of ISR. Data are limited on the optimal treatment strategy and associated outcomes. METHODS: A single institution retrospective chart review study was performed for patients who underwent endovascular treatment of femoropopliteal ISR from January 2006 to October 2008. Clinical and procedural characteristics, angiographic findings, and 12-month primary and secondary patency rates were analyzed. Univariate analysis was performed to identify predictors of 12-month primary patency. RESULTS: Twenty-two limbs were treated in 20 patients during the study period. Procedural success was achieved in 21 limbs (95.5%). Laser, balloon angioplasty, and excisional atherectomy were the primary therapy in 52.4%, 33.3%, and 14.3% of the cases, respectively. Adjunctive balloon angioplasty was performed after laser and excisional atherectomy in all cases. The mean length of ISR was 13.2 ± 11.3 cm with a significant proportion of cases (40.9%) having Type IV pattern of ISR. At 12 months, primary and combined primary-assisted and secondary patency rates were 47.6 and 61.9%, respectively. Of the 11 limbs that did not have secondary patency, 6 had mild or no symptoms, and, therefore, repeat intervention was not performed. There was one transmetatarsal amputation during the 12-month follow-up period. In this study, there was no significant predictor of 12-month primary patency. CONCLUSIONS: Treatment of ISR remains challenging with significant risk of recurrent restenosis. Further research is required to improve long-term patency.
OBJECTIVES: The aim of this study is to describe a single-center experience with endovascular treatment of femoropopliteal in-stent restenosis (ISR). BACKGROUND:Femoropopliteal artery stenting is associated with a significant risk of ISR. Data are limited on the optimal treatment strategy and associated outcomes. METHODS: A single institution retrospective chart review study was performed for patients who underwent endovascular treatment of femoropopliteal ISR from January 2006 to October 2008. Clinical and procedural characteristics, angiographic findings, and 12-month primary and secondary patency rates were analyzed. Univariate analysis was performed to identify predictors of 12-month primary patency. RESULTS: Twenty-two limbs were treated in 20 patients during the study period. Procedural success was achieved in 21 limbs (95.5%). Laser, balloon angioplasty, and excisional atherectomy were the primary therapy in 52.4%, 33.3%, and 14.3% of the cases, respectively. Adjunctive balloon angioplasty was performed after laser and excisional atherectomy in all cases. The mean length of ISR was 13.2 ± 11.3 cm with a significant proportion of cases (40.9%) having Type IV pattern of ISR. At 12 months, primary and combined primary-assisted and secondary patency rates were 47.6 and 61.9%, respectively. Of the 11 limbs that did not have secondary patency, 6 had mild or no symptoms, and, therefore, repeat intervention was not performed. There was one transmetatarsal amputation during the 12-month follow-up period. In this study, there was no significant predictor of 12-month primary patency. CONCLUSIONS: Treatment of ISR remains challenging with significant risk of recurrent restenosis. Further research is required to improve long-term patency.
Authors: Ehrin J Armstrong; Satinder Singh; Gagan D Singh; Khung-Keong Yeo; Shaan Ludder; Gregory Westin; David Anderson; David L Dawson; William C Pevec; John R Laird Journal: Catheter Cardiovasc Interv Date: 2013-06-03 Impact factor: 2.692
Authors: Michael H Vu; Glaiza-Mae Sande-Docor; Yulun Liu; Shirling Tsai; Mitul Patel; Chris Metzger; Mehdi H Shishehbor; Emmanouil S Brilakis; Nicolas W Shammas; Peter Monteleone; Subhash Banerjee Journal: J Interv Cardiol Date: 2022-07-15 Impact factor: 1.776