Osamu Iida1, Mitsuyoshi Takahara2, Yoshimitsu Soga3, Keisuke Hirano4, Yasutaka Yamauchi5, Kan Zen6, Daizo Kawasaki7, Shinsuke Nanto8, Hiroyoshi Yokoi9, Masaaki Uematsu10. 1. Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan. Electronic address: iida.osa@gmail.com. 2. Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Japan; Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan. 3. Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan. 4. Division of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama City, Japan. 5. Cardiovascular Center, Kikuna Memorial Hospital, Yokohama City, Japan. 6. Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Omihachiman, Japan. 7. Cardiovascular Division, Department of Internal Medicine, Morinomiya Hospital, Osaka, Japan. 8. Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, Suita, Japan. 9. Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka City, Japan. 10. Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan.
Abstract
OBJECTIVES: This study sought to investigate the characteristics of in-stent restenosis (ISR) after drug-eluting stent (DES) implantation for femoropopliteal (FP) lesions, and to examine 1-year prognosis after repeat endovascular therapy (re-EVT) for these DES-ISR. BACKGROUND: The morphology of DES-ISR and its association with clinical outcomes after re-EVT have not been well examined. METHODS: This was a subanalysis of the ZEPHYR (Zilver PTX for the femoral artery and proximal popliteal artery) study. The current study included 210 cases with loss of patency confirmed 1 year after DES implantation. Morphology of DES-ISR was classified into the following subgroups: class I, focal lesions (≤50 mm in length), class II, diffuse lesions (>50 mm in length), and class III, totally occluded ISR. One-year prognosis after re-EVT for DES-ISR was assessed by restenosis and major adverse limb events (MALE). RESULTS: Classes I, II, and III accounted for 50%, 25%, and 25% of DES-ISR, respectively. Factors associated with the morphology of DES-ISR were the presence of chronic total occlusion and the size of the external elastic membrane area before DES implantation (p = 0.009 and 0.017). Compared with the class I restenotic lesion, the class II and III lesions had a significantly higher risk of restenosis (74% and 78% vs. 53%: p = 0.048 and 0.019, respectively) and MALE (56% and 56% versus 32%: p = 0.025 and 0.022, respectively) 1 year after re-EVT. CONCLUSIONS: We evaluated the characteristics of ISR after DES implantation for FP lesions and 1-year prognosis of re-EVT for DES-ISR. The morphology of DES-ISR had a significant association with 1-year prognosis after re-EVT.
OBJECTIVES: This study sought to investigate the characteristics of in-stent restenosis (ISR) after drug-eluting stent (DES) implantation for femoropopliteal (FP) lesions, and to examine 1-year prognosis after repeat endovascular therapy (re-EVT) for these DES-ISR. BACKGROUND: The morphology of DES-ISR and its association with clinical outcomes after re-EVT have not been well examined. METHODS: This was a subanalysis of the ZEPHYR (Zilver PTX for the femoral artery and proximal popliteal artery) study. The current study included 210 cases with loss of patency confirmed 1 year after DES implantation. Morphology of DES-ISR was classified into the following subgroups: class I, focal lesions (≤50 mm in length), class II, diffuse lesions (>50 mm in length), and class III, totally occluded ISR. One-year prognosis after re-EVT for DES-ISR was assessed by restenosis and major adverse limb events (MALE). RESULTS: Classes I, II, and III accounted for 50%, 25%, and 25% of DES-ISR, respectively. Factors associated with the morphology of DES-ISR were the presence of chronic total occlusion and the size of the external elastic membrane area before DES implantation (p = 0.009 and 0.017). Compared with the class I restenotic lesion, the class II and III lesions had a significantly higher risk of restenosis (74% and 78% vs. 53%: p = 0.048 and 0.019, respectively) and MALE (56% and 56% versus 32%: p = 0.025 and 0.022, respectively) 1 year after re-EVT. CONCLUSIONS: We evaluated the characteristics of ISR after DES implantation for FP lesions and 1-year prognosis of re-EVT for DES-ISR. The morphology of DES-ISR had a significant association with 1-year prognosis after re-EVT.
Authors: John A Laird; Peter A Schneider; Michael R Jaff; Marianne Brodmann; Thomas Zeller; D Chris Metzger; Prakash Krishnan; Dierk Scheinert; Antonio Micari; Hong Wang; Michele Masters; Gunnar Tepe Journal: Circ Cardiovasc Interv Date: 2019-06-14 Impact factor: 6.546