Potential mechanisms of in-stent occlusion in the femoropopliteal artery: an angioscopic assessment
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ORIGINAL ARTICLE
Potential mechanisms of in-stent occlusion in the femoropopliteal artery: an angioscopic assessment Takayuki Ishihara1 • Osamu Iida1 • Shin Okamoto1 • Masashi Fujita1 • Masaharu Masuda1 • Kiyonori Nanto1 • Tatsuya Shiraki1 • Takashi Kanda1 Takuya Tsujimura1 • Shota Okuno1 • Koji Yanaka1 • Masaaki Uematsu1
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Received: 5 May 2016 / Accepted: 9 July 2016 Japanese Association of Cardiovascular Intervention and Therapeutics 2016
Abstract Although stent implantation has become widespread for the treatment of patients with peripheral artery disease with femoropopliteal (FP) lesions, in-stent restenosis, especially in-stent occlusion (ISO), remains as a major concern for refractory recurrence. Furthermore, the mechanisms of ISO in FP lesions have not been well elucidated. We performed angioscopy for 6 lesions (baremetal stent: 3, drug-eluting stent: 3) from 5 patients (mean age 74 ± 10 years, male 40 %) with ISO in the FP artery immediately after wire-passing or thrombus aspiration. The presence of thrombus as well as the presence and location of organic stenosis were evaluated. Median duration from stent implantation to angioscopic evaluation was 1099.5 (514.5–2272.5) days, while the duration from recurrence of symptoms to angioscopic evaluation was 45 (5.75–60) days. Mixed thrombi were observed in all stents. Organic stenosis was detected at the proximal edge of the stents in 5 lesions. Organic stenosis was observed at the overlapping segment of the stent in one lesion. The distal edge of the stents could be evaluated in 3 lesions, and all of them showed organic stenosis at the site. Mixed thrombi and organic stenosis were observed in all stents. Partial development of organic stenosis in a stent followed by thrombus formation may be the potential mechanism of the development of ISO in the FP artery though the sample size of this study was small and it had no serial angioscopic data so that we should consider it as preliminary one at best.
& Takayuki Ishihara [email protected] 1
Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki 660-8511, Japan
Keywords Angioscopy Femoropopliteal artery In-stent occlusion
Introduction Endovascular therapy (EVT) using nitinol stents has been widely applied to the revascularization of patients with peripheral artery disease presenting with femoropopliteal (FP) lesions due to acceptable durability compared to balloon angioplasty [1]. However, the restenosis rate at 1 year is still as high as approximately 20–40 %, and instent occlusion (ISO) in particular shows a poorer prognosis after the repeated endovascular approach [2]. The potential mechanism of ISO has also not been well elucidated. Angioscopy can directly visualize the intravascular characteristics in the FP artery [3–5]. We, therefore, evaluated the potential mechanisms of ISO in the FP artery using angioscopy.
Methods Patients This study comprised 6 lesions from 5 patients with ISO in the FP artery (mean age 74 ± 10 years, male 40 %). The lesions were treated with 3 bare-met
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