Treatment of Femoropopliteal In-Stent Restenosis With Paclitaxel-Eluting Stents

Abstract

Treatment of femoropopliteal ISR with paclitaxel-eluting stents results in favorable acute, midterm, and long-term outcomes. (Zilver PTX Global Registry [ZILVER-PTX]; NCT01094678).

Drug-Coated Balloon Versus Standard Balloon for Superficial Femoral Artery In-Stent Restenosis

“…The majority of previously assessed data on SFA ISR treatment have not been convincing. Results have been derived from single-arm observations (DCBA 12,13 ), historical comparisons (DCBA versus POBA 14 ), subgroup analyses (drug-eluting stent 18 ), studies on specific lesions (chronic total occluded ISR 19 ), and initial experiments (cutting balloon versus POBA 17 ). In some cases, high rates of bailout stenting (10% 13 and 15.9% 14 ) or additional laser mediated debulking (10% 13 ) weaken the significance of the findings.…”

Drug-Eluting Stents Are the Default Strategy for Superficial Femoral Artery Intervention Now

“…This registry represents the largest prospective assessment of ISR treatment, including 108 patients and 119 lesions (mean length 133 mm, 33.6% > 150 mm, 31.1% total occlusion, 8.4% with severe stent fracture). 67 One-year PP was 78.8%. Freedom from TlR was 81% at 1 year and 60.8% at 2 years.…”

“…67 At this point, it is impossible to assess the role of DEB in this application, because series examining their use have been small, with widely discrepant 1 year patency (38% to 92%), sometimes achieved with adjunctive stent placement. 69,70 RCTs comparing DEB with PTA are currently enrolling, 67 but, given the strikingly poor results with PTA in this application, even positive studies will prove little.…”

Management of Patients After Endovascular Interventions for Peripheral Artery Disease

“…However, recent data suggest that this may be a less frequent phenomenon in newer compared with older stent designs, with later studies reporting rates of 2% to 3% at 12 months after implantation. 16,20,43,44 In patients undergoing infrapopliteal interventions for critical limb ischemia, patency of the tibial vessels and thus their surveillance may be clinically less important after the wound heals and metabolic requirements of the pedal tissues return to a low level. Nevertheless, duplex ultrasound can be useful in imaging tibial stents and assessing their patency (Figure 4).…”