Thomas Gary1, Florian Prüller2,3, Reinhard Raggam4,5, Elisabeth Mahla6,7, Philipp Eller8, Franz Hafner9, Marianne Brodmann10. 1. Division of Angiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. thomas.gary@medunigraz.at. 2. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria. florian.prueller@klinikum-graz.at. 3. Research Unit for Perioperative Platelet Function Testing, Medical University of Graz, Graz, Austria. florian.prueller@klinikum-graz.at. 4. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria. reinhard.raggam@klinikum-graz.at. 5. Research Unit for Perioperative Platelet Function Testing, Medical University of Graz, Graz, Austria. reinhard.raggam@klinikum-graz.at. 6. Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria. elisabeth.mahla@medunigraz.at. 7. Research Unit for Perioperative Platelet Function Testing, Medical University of Graz, Graz, Austria. elisabeth.mahla@medunigraz.at. 8. Division of Angiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. philipp.eller@medunigraz.at. 9. Division of Angiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. franz.hafner@klinikum-graz.at. 10. Division of Angiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. marianne.brodmann@medunigraz.at.
Abstract
PURPOSE: Although platelet reactivity is routinely inhibited with aspirin after percutaneous angioplasty (PTA) in peripheral arteries, the restenosis rate in the superficial femoral artery (SFA) is high. Interaction of activated platelets and the endothelium in the region of intervention could be one reason for this as collagen in the subendothelium activates platelets. MATERIALS AND METHODS: A prospective study evaluating on-site platelet reactivity during PTA and its influence on the development of restenosis with a total of 30 patients scheduled for PTA of the SFA. Arterial blood was taken from the PTA site after SFA; platelet function was evaluated with light transmission aggregometry. After 3, 6, 12, and 24 months, duplex sonography was performed and the restenosis rate evaluated. RESULTS: Eight out of 30 patients developed a hemodynamically relevant restenosis (>50 % lumen narrowing) in the PTA region during the 24-month follow-up period. High residual collagen-induced platelet reactivity defined as AUC >30 was a significant predictor for the development of restenosis [adjusted odds ratio 11.8 (9.4, 14.2); P = .04]. CONCLUSIONS: High residual collagen-induced platelet reactivity at the interventional site predicts development of restenosis after PTA of the SFA. Platelet function testing may be useful for identifying patients at risk.
PURPOSE: Although platelet reactivity is routinely inhibited with aspirin after percutaneous angioplasty (PTA) in peripheral arteries, the restenosis rate in the superficial femoral artery (SFA) is high. Interaction of activated platelets and the endothelium in the region of intervention could be one reason for this as collagen in the subendothelium activates platelets. MATERIALS AND METHODS: A prospective study evaluating on-site platelet reactivity during PTA and its influence on the development of restenosis with a total of 30 patients scheduled for PTA of the SFA. Arterial blood was taken from the PTA site after SFA; platelet function was evaluated with light transmission aggregometry. After 3, 6, 12, and 24 months, duplex sonography was performed and the restenosis rate evaluated. RESULTS: Eight out of 30 patients developed a hemodynamically relevant restenosis (>50 % lumen narrowing) in the PTA region during the 24-month follow-up period. High residual collagen-induced platelet reactivity defined as AUC >30 was a significant predictor for the development of restenosis [adjusted odds ratio 11.8 (9.4, 14.2); P = .04]. CONCLUSIONS: High residual collagen-induced platelet reactivity at the interventional site predicts development of restenosis after PTA of the SFA. Platelet function testing may be useful for identifying patients at risk.