Edge restenosis of a polytetrafluoroethylene-covered stent in the superficial femoral artery: insights from an imaging a
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IMAGES IN CARDIOVASCULAR INTERVENTION
Edge restenosis of a polytetrafluoroethylene‑covered stent in the superficial femoral artery: insights from an imaging assessment with an electronic high‑resolution angioscope Yuji Nishimoto1 · Rei Fukuhara1 · Tadashi Miyamoto1 · Masanao Toma1 · Akihiko Miyata1 · Yukihito Sato1 Received: 11 January 2019 / Accepted: 12 March 2019 © Japanese Association of Cardiovascular Intervention and Therapeutics 2019
Introduction A 70-year-old woman underwent endovascular treatment (EVT) of the superficial femoral artery (SFA). Pre-procedural angiography revealed a proximal edge 17-month restenosis of a heparin-bonded expanded polytetrafluoroethylene (ePTFE)-covered stent (Viabahn, W. L. Gore, Flagstaff, AZ, USA) (Fig. 1a). After a proximal balloon occlusion using an 8.3-Fr Optimo balloon-guiding catheter (Tokai Medical Products, Aichi, Japan) and blockage of the blood flow (Fig. 1b, c), an electronic high-resolution angioscope (Zemporshe, OVALIS, Osaka, Japan) (Fig. 1d–g; Supplement Movie 1, 2), which had an image sensor with a 0.48-megapixel equivalent resolution at the distal tip, demonstrated neointimal hyperplasia (Fig. 1e), and mural thrombi around the distal edge despite neointimal coverage (Fig. 1g). After dilatation with a 5.0 mm cutting balloon (Fig. 1h), the Zemporshe angioscope demonstrated a crack in the neointima and an enlargement of the lumen area (Fig. 1i; Supplement Movie 3). After dilatation with a 5.0 mm paclitaxel-eluting balloon (IN.PACT, Medtronic, Minneapolis, Minnesota) (Fig. 1j), a final angiogram showed that the lesion had become well expanded without a major dissection (Fig. 1k). The Viabahn stent has become increasingly used for SFA-EVT; however, edge restenosis and thromboses have remained critical problems, [1] and these mechanisms have
not yet been adequately elucidated. The angioscope provides full-color real-time images of the luminal vessel wall and can detect thrombi more frequently than other imaging modalities [2]. The Zemporshe angioscope can provide higher resolution and larger angle images compared with conventional fiberoptic angioscopes, [3] therefore, it is feasible for the qualitative assessment of restenosis of Viabahn stents. In this case, the Zemporshe angioscope showed the detailed morphology of an edge restenosis of a Viabahn stent, effect of dilatation with a cutting balloon, and mural thrombi. The ePTFE folds at the proximal stent edge might cause a malapposition and subsequent edge restenosis. The Zemporshe angioscope could visualize the ePTFE, but its folds were not visualized. We also have to observe them just after the implantation of the Viabahn stent.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12928-019-00583-z) contains supplementary material, which is available to authorized users. * Yuji Nishimoto [email protected] 1
Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, 2‑17‑77 Higashinaniwa‑cho, Amagasaki 660‑8550, Japan
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