Laser Atherectomy for Treatment of Femoropopliteal In-Stent Restenosis

Abstract

When used to treat complex ISR, including in-stent occlusions, laser atherectomy with adjunctive balloon angioplasty may be associated with improved patency.

Commentary: Excimer Laser in Treating Femoropopliteal In-Stent Restenosis

“…Armstrong et al 16 confirmed prior observations that operators appear to select the laser for longer (222 vs 114 mm) and more complex lesions (total occlusions 69% vs 20%) than BA, respectively. Shammas et al 27 noted the same when laser was compared with SilverHawk (Medtronic CardioVascular, Santa Rosa, CA, USA) for treating femoropopliteal ISR.…”

“…The problems with stenting the femoropopliteal segment are well illustrated by Armstrong et al 16 in this issue of the JEVT. In this "real world" retrospective study, stent fractures at index were observed in 10% to 11% of patients.…”

“…Armstrong and colleagues 16 have interestingly shown in their study that the TLR at 2 years in short lesions and nonocclusive disease favored the laser compared with BA (14% vs 44%, respectively) despite the significantly longer lesions in the laser cohort. This finding contrasts with the 6-month follow-up of EXCITE, and it could be related to chance although one cannot exclude the possibility that short lesions may to do better with the laser vs BA on longterm follow-up.…”

Laser atherectomy and drug‐coated balloons for the treatment of femoropopliteal in‐stent restenosis: 2‐Year outcomes

“…In a recent report, Milnerowicz et al studied the combination of RA + DCB for the treatment of iliac and infrainguinal in‐stent occlusions and achieved a 12‐month freedom from restenosis rate of 79.5% and 12‐month freedom from TLR 94.5% . LA helps debulk the neointimal tissue from the restenosed stent and therefore decreases recoil before balloon inflation . At the same time, by offering plaque modification and creating micropores, it may facilitate paclitaxel uptake and retention in the lesion .…”

“…32 Apart from our group, LA in combination with DCB has been studied also in a single-center RCT by Gandini et al 36 LA helps debulk the neointimal tissue from the restenosed stent and therefore decreases recoil before balloon inflation. 37 At the same time, by offering plaque modification and creating micropores, it may facilitate paclitaxel uptake and retention in the lesion. 7,[38][39][40] As a result, LA and DCB likely have synergistic effects.…”