Takayuki Ishihara1, Mitsuyoshi Takahara2,3, Osamu Iida4, Yoshimitsu Soga5, Keisuke Hirano6, Yasutaka Yamauchi7, Kan Zen8, Daizo Kawasaki9, Shinsuke Nanto10, Hiroyoshi Yokoi11, Masaaki Uematsu1. 1. Kansai Rosai Hospital Cardiovascular Center, Hyogo, Japan. 2. Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. 3. Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. 4. Kansai Rosai Hospital Cardiovascular Center, Hyogo, Japan iida.osa@gmail.com. 5. Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan. 6. Division of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Kanagawa, Japan. 7. Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan. 8. Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Shiga, Japan. 9. Cardiovascular Division, Department of Internal Medicine, Morinomiya Hospital, Osaka, Japan. 10. Nishinomiya Municipal Central Hospital, Hyogo, Japan. 11. Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan.
Abstract
PURPOSE: To report midterm outcomes after subintimal vs intraluminal drug-eluting stent (DES) implantation for femoropopliteal (FP) chronic total occlusion (CTO). METHODS: This subanalysis of the prospective, multicenter ZEPHYR study (ZilvEr PTX for tHe Femoral ArterY and Proximal Popliteal ArteRy) included 176 patients (mean age 74±8 years; 130 men) with 192 de novo FP CTOs that were evaluated by intravascular ultrasound after successful guidewire crossing. The primary outcome was the 2-year restenosis rate after subintimal (n=73) or intraluminal (n=119) DES implantation. Propensity score matching extracted 61 matched pairs (mean age 75 years; 49 men) for patency analysis to minimize baseline intergroup differences. Restenosis rates are reported with the 95% confidence interval (CI). RESULTS: The 1-year restenosis rates in the groups with subintimal and intraluminal DES implantation were 45% (95% CI 32% to 59%) and 35% (95% CI 22% to 49%), respectively (p=0.352), whereas the corresponding rates at 2 years were not significantly different (p=0.648) at 56% (95% CI 41% to 71%) and 51% (95% CI 34% to 68%). Baseline characteristics had no significant interaction effect on the association of subintimal angioplasty with restenosis risk. CONCLUSION: In FP CTO, 2-year restenosis rates were comparable after subintimal or intraluminal DES implantation.
PURPOSE: To report midterm outcomes after subintimal vs intraluminal drug-eluting stent (DES) implantation for femoropopliteal (FP) chronic total occlusion (CTO). METHODS: This subanalysis of the prospective, multicenter ZEPHYR study (ZilvEr PTX for tHe Femoral ArterY and Proximal Popliteal ArteRy) included 176 patients (mean age 74±8 years; 130 men) with 192 de novo FP CTOs that were evaluated by intravascular ultrasound after successful guidewire crossing. The primary outcome was the 2-year restenosis rate after subintimal (n=73) or intraluminal (n=119) DES implantation. Propensity score matching extracted 61 matched pairs (mean age 75 years; 49 men) for patency analysis to minimize baseline intergroup differences. Restenosis rates are reported with the 95% confidence interval (CI). RESULTS: The 1-year restenosis rates in the groups with subintimal and intraluminal DES implantation were 45% (95% CI 32% to 59%) and 35% (95% CI 22% to 49%), respectively (p=0.352), whereas the corresponding rates at 2 years were not significantly different (p=0.648) at 56% (95% CI 41% to 71%) and 51% (95% CI 34% to 68%). Baseline characteristics had no significant interaction effect on the association of subintimal angioplasty with restenosis risk. CONCLUSION: In FP CTO, 2-year restenosis rates were comparable after subintimal or intraluminal DES implantation.