Intravascular Ultrasound Measurements After Drug-Eluting Stent Placement in Femoropopliteal Lesions

Mori, Shinsuke; Hirano, Keisuke; Muramatsu, Toshiya; Tsukahara, Reiko; Ito, Yoshiaki; H, Ito

doi:10.1177/1526602815580308

Cited by 25 publications

(19 citation statements)

References 46 publications

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“…Several studies revealed that the distal reference lumen/EEM CSA was useful to predict TLR after stent implantation for FP lesions 16, 18, 19) , which is consistent with our results. The results of the present study suggest that restenosis risk after EVT for long occlusive lesions with small vessel is high.…”

Section: Discussionsupporting

confidence: 92%

“…The definition of stent thrombosis was the same as described elsewhere 18) . The definitions of IVUS parameters followed those of a previous report 19) . Wire passage in occlusive lesions was classified according to IVUS findings: intraplaque, inside the plaque; subintimal, between the plaque and media; and intramedial, between the media and adventitia 11) .…”

Section: Methodsmentioning

confidence: 99%

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Clinical Outcomes of the Intraluminal Approach for Long Occlusive Femoropopliteal Lesions Assessed by Intravascular Ultrasound

Mori

Hirano

Ito

et al. 2017

JAT

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Aim: To investigate the relationship between intravascular ultrasound (IVUS) findings and restenosis after stent implantation for long occlusive femoropopliteal (FP) lesions using the intraluminal approach.Methods: This was a single-center retrospective study of 45 patients (49 lesions) with de novo long occlusive FP lesions treated with bare metal stents implanted using the intraluminal approach under IVUS guidance from April 2007 to December 2014. All patients were followed up at least 12 months. The preprocedural and postprocedural IVUS findings were compared for patients with and without restenosis, which was defined as a peak systolic velocity ratio of > 2.4 on duplex ultrasonography or > 50% diameter stenosis on angiography.Results: Within 12 months, 13 patients (14 lesions) developed restenosis, whereas 32 patients (35 lesions) did not (restenosis rate = 29%). The male:female ratio and the prevalence of diabetes mellitus, hemodialysis, and critical limb ischemia were similar between the two groups. No significant differences were observed in lesion length, chronic total occlusion (CTO) length, and the percentage of involving popliteal lesion between the two groups. A whole intraplaque route was gained in 15 lesions (31%). Multivariate analysis revealed that the within-CTO intramedial route proportion and the distal lumen cross-sectional area (CSA) were independent predictors of restenosis. Receiver operating characteristic analysis showed that the best cutoff values of these parameters were 14.4% and 17.7 mm2, respectively.Conclusions: In patients with long occlusive FP lesions undergoing stent placement using the intraluminal approach, a whole intraplaque route was gained in 31%. Restenosis is more likely if IVUS shows a within-CTO intramedial route proportion of > 14.4% or distal lumen CSA of < 17.7 mm2.

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Clinical Outcomes of the Intraluminal Approach for Long Occlusive Femoropopliteal Lesions Assessed by Intravascular Ultrasound

Mori

Hirano

Ito

et al. 2017

JAT

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“…Intravascular imaging to support diagnosis and treatment of peripheral artery disease is becoming an important factor in new and evolving endovascular interventions. Use of such imaging can help form the treatment strategy, size the vessel so that the appropriate diameter of balloons or stents being placed is chosen, and guide and direct treatments such as angioplasty and atherectomy to minimize vessel wall injury [6,[27][28][29][30][31]. Intravascular imaging also permits assessment of tissue in the region of the procedure in order to determine whether further treatment is necessary to address regions with incomplete treatment or injury resulting from the treatment [30,32,33].…”

Section: Discussionmentioning

confidence: 99%

A post-market, multi-vessel evaluation of the imaging of peripheral arteries for diagnostic purposeS comparing optical Coherence tomogrApy and iNtravascular ultrasound imaging (SCAN)

Pavillard

Sewall

2020

BMC Med Imaging

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Background: Intravascular imaging plays an important part in diagnosis of vascular conditions and providing insight for treatment strategy. Two main imaging modalities are intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The objective of this study was to prove non-inferiority of OCT imaging to IVUS images in matched segments of peripheral vessels in patients with suspected peripheral vascular disease. Methods: The SCAN study was a prospective, non-inferiority clinical study of matched IVUS and OCT images collected along defined segments of peripheral vessels from twelve subjects (mean age 68 ± 10.3 years; 10 men) displaying symptoms of vascular disease. Luminal diameters were measured by both imaging systems at the distal, middle, and proximal points of the defined segments. Three blinded interventional radiologists evaluated the quality of both imaging modalities in identifying layered structures (3-point grading), plaque (5-point grading), calcification (5-point grading), stent structure (3-point grading), and artifacts (3-point grading) from 240 randomly ordered images. Mean grading scores and luminal diameters were calculated and analyzed with Student's t-Test and Mann-Whitney-Wilcoxon testing. Intrareader reproducibility was calculated by intraclass correlation (ICC) analysis. Results: The mean scoring of plaque, calcification, and vascular stent struts by the three readers was significant better in terms of image quality for OCT than IVUS (p < 0.001, p = 0.001, p = 0.004, respectively). The mean scores of vessel wall component visibility and artifacts generated by the two imaging systems were not significantly different (p = 0.19, p = 0.07, respectively). Mean vessel luminal diameter and area at three specific locations within the vessels were not significantly different between the two imaging modalities. No patient injury, adverse effect or device malfunction were noted during the study. Conclusions: Imaging by OCT provides the physician with better visualization of some vessel and plaque chacteristics, but both IVUS and OCT imaging are safe and effective methods of examining peripheral vessels in order to perform diagnostic assessment of peripheral vessels and provide information necessary for the treatment strategy of peripheral artery disease. Trial registration: NCT03480685 registered on 29 March 2018.

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“…Adjunctive IVUS imaging allows for greater understanding of lesion morphology, residual stenosis, adventitial injury and results in improved primary patency. [15][16][17][18] The use of IVUS in the coronary vasculature has been shown to increase luminal diameter by allowing for more accurate sizing of the vessel and thereby allowing for larger balloons to significantly improve luminal diameter without increasing dissection. 19 Aggressive debulking has been previously postulated to delay re-intervention for these femoropopliteal in-stent restenosis patients.…”

Section: Discussionmentioning

confidence: 99%

Intravascular ultrasound guided directional atherectomy versus directional atherectomy guided by angiography for the treatment of femoropopliteal in-stent restenosis

Ramanathan

Tarricone

Purushothaman

et al. 2017

Therapeutic Advances in Cardiovascular Disease

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Intravascular Ultrasound Measurements After Drug-Eluting Stent Placement in Femoropopliteal Lesions

Abstract: IVUS guidance of DES placement in femoropopliteal lesions can offer useful predictors of restenosis at 1 year. The utility of distal lumen CSA and the axial symmetry index in the prediction of restenosis after femoropopliteal DES placement should be confirmed in a larger cohort.

Cited by 25 publications

References 46 publications

Clinical Outcomes of the Intraluminal Approach for Long Occlusive Femoropopliteal Lesions Assessed by Intravascular Ultrasound

Clinical Outcomes of the Intraluminal Approach for Long Occlusive Femoropopliteal Lesions Assessed by Intravascular Ultrasound

A post-market, multi-vessel evaluation of the imaging of peripheral arteries for diagnostic purposeS comparing optical Coherence tomogrApy and iNtravascular ultrasound imaging (SCAN)

Intravascular ultrasound guided directional atherectomy versus directional atherectomy guided by angiography for the treatment of femoropopliteal in-stent restenosis

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