Treatment of Femoropopliteal Artery In-stent Restenosis

Kim, Won-Ho; Choi, Donghoon

doi:10.4070/kcj.2018.0074

Cited by 12 publications

(9 citation statements)

References 29 publications

(27 reference statements)

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“…This finding is consistent with the observation that the largest lumen remodeling in SFAs occurs at 1Y post-intervention. 19 Overall, similar results were found by analyzing the ISR progression of both the entire lesions and segments of the lesions. Specifically, the lumen remodeling trajectory (i.e.…”

Section: Morphological Progressionsupporting

confidence: 79%

“…This finding is consistent with the observation that the largest lumen remodeling in SFAs occurs at 1Y post-intervention. 19 …”

Section: Discussionmentioning

confidence: 99%

“… 32 The incidence of ISR in this vascular region ranges from 15% to 32%, with a peak between 9 and 15 months after intervention. 19 Besides the common clinical promoters, such as diabetes and age, 14 some conditions, including vessel tortuosity, 22 device length, 14 stent overlapping, 34 and biomechanical factors have been identified as concurrent drivers of ISR. Specifically, two biomechanical factors are deemed to promote ISR: (i) the arterial wall injury provoked by the endovascular procedure, 31 which contributes to ISR initiation, and (ii) the altered local hemodynamics immediately after stenting and during the entire post-operative period, 27 stimulating both ISR initiation and progression.…”

Section: Introductionmentioning

confidence: 99%

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In-Stent Restenosis Progression in Human Superficial Femoral Arteries: Dynamics of Lumen Remodeling and Impact of Local Hemodynamics

Colombo

Corti

et al. 2021

Ann Biomed Eng

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In-stent restenosis (ISR) represents a major drawback of stented superficial femoral arteries (SFAs). Motivated by the high incidence and limited knowledge of ISR onset and development in human SFAs, this study aims to (i) analyze the lumen remodeling trajectory over 1-year follow-up period in human stented SFAs and (ii) investigate the impact of altered hemodynamics on ISR initiation and progression. Ten SFA lesions were reconstructed at four follow-ups from computed tomography to quantify the lumen area change occurring within 1-year post-intervention. Patient-specific computational fluid dynamics simulations were performed at each follow-up to relate wall shear stress (WSS) based descriptors with lumen remodeling. The largest lumen remodeling was found in the first post-operative month, with slight regional-specific differences (larger inward remodeling in the fringe segments, p < 0.05). Focal re-narrowing frequently occurred after 6 months. Slight differences in the lumen area change emerged between long and short stents, and between segments upstream and downstream from stent overlapping portions, at specific time intervals. Abnormal patterns of multidirectional WSS were associated with lumen remodeling within 1-year post-intervention. This longitudinal study gave important insights into the dynamics of ISR and the impact of hemodynamics on ISR progression in human SFAs.

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Section: Morphological Progressionsupporting

confidence: 79%

“…This finding is consistent with the observation that the largest lumen remodeling in SFAs occurs at 1Y post-intervention. 19 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

In-Stent Restenosis Progression in Human Superficial Femoral Arteries: Dynamics of Lumen Remodeling and Impact of Local Hemodynamics

Colombo

Corti

et al. 2021

Ann Biomed Eng

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“…However, major concerns about the durability of this outcome have been raised, specifically regarding the mid- and long-term in-stent restenosis (ISR) and stent fracture 12 – 14 . Indeed, at the same time, it is estimated that about 30% to 40% of stented patients will require repeated revascularization (usually surgical) at the same lesion site 13 , following vessel re-occlusion within 12 months 15 , with an ISR peak occurring between 9 and 15 months after the endovascular procedure 16 . Furthermore, it was reported that, after 2 years, the occurrence of ISR in SFA is reduced and the lesions seem more related to the evolution of atheromatous disease rather than neointimal hyperplasia 17 , 18 .…”

Section: Introductionmentioning

confidence: 99%

Baseline local hemodynamics as predictor of lumen remodeling at 1-year follow-up in stented superficial femoral arteries

Colombo

Corti

et al. 2021

Sci Rep

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In-stent restenosis (ISR) is the major drawback of superficial femoral artery (SFA) stenting. Abnormal hemodynamics after stent implantation seems to promote the development of ISR. Accordingly, this study aims to investigate the impact of local hemodynamics on lumen remodeling in human stented SFA lesions. Ten SFA models were reconstructed at 1-week and 1-year follow-up from computed tomography images. Patient-specific computational fluid dynamics simulations were performed to relate the local hemodynamics at 1-week, expressed in terms of time-averaged wall shear stress (TAWSS), oscillatory shear index and relative residence time, with the lumen remodeling at 1-year, quantified as the change of lumen area between 1-week and 1-year. The TAWSS was negatively associated with the lumen area change (ρ = − 0.75, p = 0.013). The surface area exposed to low TAWSS was positively correlated with the lumen area change (ρ = 0.69, p = 0.026). No significant correlations were present between the other hemodynamic descriptors and lumen area change. The low TAWSS was the best predictive marker of lumen remodeling (positive predictive value of 44.8%). Moreover, stent length and overlapping were predictor of ISR at follow-up. Despite the limited number of analyzed lesions, the overall findings suggest an association between abnormal patterns of WSS after stenting and lumen remodeling.

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“…Bare metal stents implantation is commonly used. Stents resolve the problems of elastic recoil, residual stenosis and dissection but ISR stay high with an incidence of 15% to 32% in 12 months (3,9). Dick et al showed the ISR treatment with angioplasty resulted in a restenosis recurrence rate with up to 73% (10).…”

Section: Resultsmentioning

confidence: 99%

Percutaneous mechanical atherothrombectomy using the Rotarex®S device in peripheral artery in-stent restenosis or occlusion: a French retrospective multicenter study on 128 patients

Loffroy¹,

Edriss²,

Goyault³

et al. 2020

Quant Imaging Med Surg

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Background: To ascertain the safety and mid-term outcomes of Rotarex ® S rotational atherectomy plus thrombectomy device (Straub Medical AG, Wangs, Switzerland) with or without adjunctive treatment (e.g., percutaneous transluminal angioplasty, PTA/drug-coated balloon, DCB/stenting) in patients with in-stent restenosis (ISR) or occlusion in the iliac and/or infrainguinal arteries.Methods: French multicenter retrospective study of all patients treated by in-stent percutaneous mechanical debulking (PMD) of the lower limbs with Rotarex ® S device between January 2013 and November 2018. Results:The cohort consisted of 128 patients (88 men and 40 women), aged 39-94 years (mean, 66.7±12 years). All patients presented with cardio-vascular risk factors. Overall, 51.5% of patients had critical limb ischemia. The study demonstrated a technical success of 96.9% in the population with PMD and adjunctive PTA (95/128, 74.2%) or adjunctive DCB (16/128, 12.5%) or both (13/128, 10.2%). At 12-months follow-up, the primary clinical success/patency rate was 92.3% and the secondary clinical success/patency rate was 91.4%. Rate of limb salvage was 93.7%. Overall 32 (25%) reinterventions were reported with mean time from Rotarex ® S treatment to reintervention of 7.1±8.2 months. Target lesion revascularization (TLR) was 19.5% (25/128). Seven (5.5%) patients developed distal embolism that responded to endovascular treatment. At mean follow-up, major adverse events (MAE) observed were death (18/128, 14.1%), myocardial infarction (MI) (9/128, 7.0%), stroke (2/128, 1.6%) and renal failure (3/128, 2.3%).Conclusions: Recanalization with Rotarex ® S rotational atherectomy plus thrombectomy device is a practical choice for arterial ISR/occlusions of the iliac and/or infrainguinal arteries, regardless of the age of the thrombus, with satisfying TLR. Only adjunctive PTA is often necessary to further improve the recanalization.

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Treatment of Femoropopliteal Artery In-stent Restenosis

Cited by 12 publications

References 29 publications

In-Stent Restenosis Progression in Human Superficial Femoral Arteries: Dynamics of Lumen Remodeling and Impact of Local Hemodynamics

In-Stent Restenosis Progression in Human Superficial Femoral Arteries: Dynamics of Lumen Remodeling and Impact of Local Hemodynamics

Baseline local hemodynamics as predictor of lumen remodeling at 1-year follow-up in stented superficial femoral arteries

Percutaneous mechanical atherothrombectomy using the Rotarex®S device in peripheral artery in-stent restenosis or occlusion: a French retrospective multicenter study on 128 patients

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