Serial optical coherence tomography assessments at 2- and 4-month follow-up after paclitaxel-eluting stenting of the sup
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CASE REPORT
Serial optical coherence tomography assessments at 2- and 4-month follow-up after paclitaxel-eluting stenting of the superficial femoral artery Hideaki Aihara • Yoshimitsu Soga Shoichi Kuramitsu
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Received: 28 September 2013 / Accepted: 26 March 2014 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2014
Abstract A 71-year-old man underwent endovascular therapy (EVT) with a paclitaxel-eluting stent in superficial femoral artery (SFA). Optical coherence tomography (OCT) of SFA at 2 months after EVT revealed that several struts were not covered with neointima. Moreover, some mural thrombi were detected within the stent. Although OCT revealed that the frequency of stent strut coverage was improved at the 4-month follow-up, uncovered stent strut still remained and some mural thrombi were observed within the stent even at 4 months after EVT. This is the first report to demonstrate the vascular response after paclitaxel-eluting stent placement for the lesion using serial OCT examinations.
better than that of EVT [4, 5, 6]. According to the TransAtlantic Inter-Society Consensus (TASC)-II guideline, the long-term patency of bypass surgery is superior to that of EVT in patients with intermittent claudication. Although the primary patency rate of EVT has been lower than that of bypass surgery, the Zilver PTX stent is the first drug-eluting stent (DES) to have been available for femoropopliteal disease, and which has been reported more effective than bare metal stent (BMS) [7, 8]. Therefore, DES is expected to an important role in the EVT for patients with femoropopliteal disease. Furthermore, antiplatelet therapy becomes important in case of using DES for peripheral arterial disease.
Keywords Endovascular therapy Paclitaxel-eluting stent Optical coherence tomography Superficial femoral artery Antiplatelet therapy
Case report
Introduction The best way to manage peripheral arterial disease remains an unresolved issue. For patients with intermittent claudication, exercise and optimal medical management are firstline therapies [1, 2, 3]. If these treatments are ineffective, endovascular therapy (EVT) or bypass surgery must be performed. Generally, the outcome of bypass surgery is H. Aihara (&) Department of Cardiology, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki 305-8558, Japan e-mail: [email protected] Y. Soga S. Kuramitsu Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
A 71-year-old man underwent EVT for uncontrollable intermittent claudication in July 2012. He had multiple risk factors; dyslipidemia, hypertension, diabetes, and endstage renal failure requiring hemodialysis. Angiography of the right lower extremity artery revealed a diffuse stenosis lesion involving the middle superficial femoral artery (SFA). After pre-dilation with a 3 mm balloon catheter, a 6.0/120 mm Zilver PTX stent was deployed at the SFA lesion and post-dilation was performed with a 4 mm balloon catheter. (Fig. 1) He was discharged on dual antiplatelet
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