Restenotic patterns after FP stenting are important predictors of recurrent ISR and occlusion.

Acquiring direct flow based on the angiosome concept is important for limb salvage by EVT in patients with CLI.

The current study demonstrated 1-year real-world outcomes after drug-eluting stent treatment for FP lesions, including challenging ones in clinical practice. Lesion length, external elastic membrane area, and minimum stent area were independent predictors for restenosis. (Zilver PTX for the Femoral Artery and Proximal Popliteal Artery-Prospective Multicenter Registry [ZEPHYR]; UMIN000008433).

Clinical efficacy of nitinol stent implantation for FP disease was favorable for up to 5 years.

Background-The time course of neointimal formation after stent implantation has not been studied extensively by angioscopy in the drug-eluting stent era. Methods and Results-Serial angioscopic findings at first follow-up (3.6Ϯ1.1 months), second follow-up (10.5Ϯ1.6 months), and third follow-up (21.2Ϯ2.2 months) after stent implantation were compared between sirolimus-eluting stents (SES, nϭ17) and bare-metal stents (BMS, nϭ11). Neointimal coverage, thrombus, and presence of yellow plaques underneath the stents were assessed. Neointimal coverage was graded as follows: grade 0, stent struts were fully visible; grade 1, struts bulged into the lumen, although they were covered; grade 2, struts were embedded by the neointima but were seen translucently; or grade 3, struts were fully embedded and invisible. Neointimal coverage was remarkably different between SES and BMS at each follow-up point. Neointimal coverage grade was 1.1Ϯ0.5 in SES versus 2.9Ϯ0.3 in BMS at the first follow-up (PϽ0.0001), 1.1Ϯ0.5 in SES versus 3.0Ϯ0.0 in BMS (PϽ0.0001) at the second follow-up, and 1.3Ϯ0.5 in SES versus 3.0Ϯ0.0 in BMS at the third follow-up (Pϭ0.0009). No significant serial changes in coverage grade were noted in the BMS group, whereas coverage grade slightly but significantly increased at the third follow-up in the SES group (PϽ0.05). Thrombi were detected in 4 SES: a red thrombus was seen from the first to the third follow-up in 2; another was detected only at the third follow-up; and the fourth was seen at the first follow-up but disappeared at the second follow-up, associated with a new white thrombus despite dual antiplatelet therapy. Yellow plaques had disappeared by the time of the second follow-up in BMS. In contrast, yellow plaques were exposed in 71% of SES at the first follow-up and remained exposed until the third follow-up. Neointimal coverage grades correlated with thrombi (Pϭ0.002) and with yellow plaques (PϽ0.0001). Conclusions-Serial angioscopic findings up to 2 years after SES implantation were markedly different from those after BMS. Neointimal coverage was completed by 3 to 6 months in BMS. In contrast, SES demonstrated the presence of thrombi and yellow plaques even as much as 2 years after implantation. (Circulation. 2007;116:910-916.)

Achieving direct flow by angioplasty based on the angiosome concept in CLI patients with isolated BTK lesions is clinically important for AFS and freedom from MA and MALE. Limb salvage factors appear to differ between patients with and without direct flow from the feeding artery after EVT.

No abstract

Severe dissection was found in 42% of cases after PTA. A small vessel diameter and/or TASC II C/D lesions were related to a high incidence of dissection. Severe dissection during procedures employing balloon angioplasty only could affect long-term patency.