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Clinical Trial
. 2017 May 1;24(5):477-486.
doi: 10.5551/jat.36749. Epub 2016 Oct 1.

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

Shinsuke Mori  1 , Keisuke Hirano  1 , Yoshiaki Ito  1 , Masahiro Yamawaki  1 , Motoharu Araki  1 , Norihiro Kobayashi  1 , Hideyuki Takimura  1 , Yasunari Sakamoto  1 , Masakazu Tsutsumi  1 , Takuro Takama  1 , Yohsuke Honda  1 , Takahiro Tokuda  1 , Kenji Makino  1 , Shigemitsu Shirai  1
Affiliations
Clinical Trial

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

Shinsuke Mori et al. J Atheroscler Thromb. .

Abstract

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.

Keywords: Chronic total occlusion; Femoropopliteal artery; Intraluminal approach; Intravascular ultrasound.

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Figures

Fig. 1.
Fig. 1.
Study Flowchart EVT: endovascular therapy. FP: femoropopliteal. IVUS: intravascular ultrasound. DES: drug eluting stent. BMS: bare metal stent.
Fig. 2.
Fig. 2.
Receiver-operating characteristic analysis of the proportion via the intramedial route and distal reference lumen CSA for developing restenosis CSA: cross-sectional area. AUC: area under the curve. CI: confidence interval.
See this image and copyright information in PMC

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