The Characteristics of In-Stent Restenosis After Drug-Eluting Stent Implantation in Femoropopliteal Lesions and 1-Year Prognosis After Repeat Endovascular Therapy for These Lesions

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• 作者：Osamu Iida ; MD^a ; ^{iida.osa@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Mitsuyoshi Takahara ; MD ; PhD^b ; ^c ; Yoshimitsu Soga ; MD ; PhD^d ; Keisuke Hirano ; MD^e ; Yasutaka Yamauchi ; MD ; PhD^f ; Kan Zen ; MD ; PhD^g ; Daizo Kawasaki ; MD ; PhD^h ; Shinsuke Nanto ; MD ; PhDⁱ ; Hiroyoshi Yokoi ; MD^j ; Masaaki Uematsu ; MD ; PhD^a ; on behalf of the ZEPHYR InvestigatorsNobuyoshi Azuma ; Makoto Nakahama ; Junichi Tazaki ; Tsuyoshi Miyazawa ; Masashi Fukunaga ; Takahide Suzuki ; Nobuhiro Suematsu ; Yoshinori Tsubakimoto ; Taketsugu Tsuchiya ; Osamu Iida ; Atsushi Tosaka ; Yasutaka Yamauchi ; Kyozo Inoue ; Yoshimitsu Soga ; Terutoshi Yamaoka ; Daizo Kawasaki ; Kan Zen ; Masatsugu Nakano ; Keisuke Hirano ; Michiaki Higashitani ; Daisuke Ogasawara ; Kenji Suzuki ; Yoshiaki Shintani ; Yusuke Miyashita ; Norihiko Shinozaki ; Makoto Utsunomiya ; Hiroki Takahashi
• 关键词：drug-eluting stent(s) ; femoropopliteal lesion ; in-stent restenosis
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：25 April 2016
• 年：2016
• 卷：9
• 期：8
• 页码：828-834
• 全文大小：478 K

文摘

This study sought to investigate the characteristics of in-stent restenosis (ISR) after drug-eluting stent (DES) implantation for femoropopliteal (FP) lesions, and to examine 1-year prognosis after repeat endovascular therapy (re-EVT) for these DES-ISR.

Background

The morphology of DES-ISR and its association with clinical outcomes after re-EVT have not been well examined.

Methods

This was a subanalysis of the ZEPHYR (Zilver PTX for the femoral artery and proximal popliteal artery) study. The current study included 210 cases with loss of patency confirmed 1 year after DES implantation. Morphology of DES-ISR was classified into the following subgroups: class I, focal lesions (≤50 mm in length), class II, diffuse lesions (>50 mm in length), and class III, totally occluded ISR. One-year prognosis after re-EVT for DES-ISR was assessed by restenosis and major adverse limb events (MALE).

Results

Classes I, II, and III accounted for 50%, 25%, and 25% of DES-ISR, respectively. Factors associated with the morphology of DES-ISR were the presence of chronic total occlusion and the size of the external elastic membrane area before DES implantation (p = 0.009 and 0.017). Compared with the class I restenotic lesion, the class II and III lesions had a significantly higher risk of restenosis (74% and 78% vs. 53%: p = 0.048 and 0.019, respectively) and MALE (56% and 56% versus 32%: p = 0.025 and 0.022, respectively) 1 year after re-EVT.

Conclusions

We evaluated the characteristics of ISR after DES implantation for FP lesions and 1-year prognosis of re-EVT for DES-ISR. The morphology of DES-ISR had a significant association with 1-year prognosis after re-EVT.