Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 May;47(4):540-549.
doi: 10.1007/s11239-019-01826-9.

Restenosis is associated with prothrombotic plasma fibrin clot characteristics in endovascularly treated patients with critical limb ischemia

Tomasz Nowakowski  1 , Krzysztof Piotr Malinowski  2   3 , Rafał Niżankowski  4 , Teresa Iwaniec  5 , Anetta Undas  6   7
Affiliations

Restenosis is associated with prothrombotic plasma fibrin clot characteristics in endovascularly treated patients with critical limb ischemia

Tomasz Nowakowski et al. J Thromb Thrombolysis. 2019 May.

Abstract

Introduction: Hypolysible fibrin clots composed of tightly packed fibers characterize patients with peripheral artery disease (PAD) especially those with critical limb ischemia (CLI). Little is known about the impact of a prothrombotic clot phenotype on restenosis following endovascular revascularization in CLI. The goal of this study was to compare fibrin clot properties and their determinants in CLI patients with restenosis after endovascular treatment (ET) and those free of this complication.

Methods: 85 patients with CLI and restenosis within 1 year after ET on optimal pharmacotherapy and 47 PAD control patients without restenosis were included into the study. Plasma fibrin clot permeability (Ks, a measure of the average pore size in the fibrin network) and clot lysis time (CLT) with its potential determinants were determined. During follow-up, the composite endpoint including re-intervention, amputation and death was assessed.

Results: Compared with the control group, patients with restenosis had reduced Ks (- 9.5%, p < 0.001), prolonged CLT (+ 12.4%, p = 0.003), higher thrombin generation (+ 7.9%, p < 0.001) and elevated von Willebrand factor (vWF) antigen (+ 14.2%, p < 0.001). During a 24 months follow-up the composite endpoint occurred in 54 CLI patients with restenosis (63.5%) and nine control patients (19.1%, p < 0.001) with no association with baseline Ks and CLT.

Conclusion: The increased thrombin formation and unfavorable fibrin clot properties occur in patients with CLI who experienced restenosis despite optimal endovascular and pharmacological therapy.

Keywords: Endovascular treatment; Fibrin clot; In-stent restenosis; Peripheral arterial disease.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest

All authors declare that they have no potential conflicts of interest.

Ethical approval

The study was approved by the Jagiellonian University Ethics Committee, and patients provided written informed consent. The study was conducted according to the ICH-GCP guidelines and relevant local and international regulations including but not limited to the 1964 Declaration of Helsinki (WMA).

Figures

Fig. 1
Fig. 1
Study patients recruitment and selection diagram
Fig. 2
Fig. 2
Scatter plots of the permeability coefficient (Ks) and clot lysis time (CLT) measurements in patients with restenosis and control group. Lines represent mean values for both parameters, p < 0.005
See this image and copyright information in PMC

References

    1. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. TASC II Working Group. Inter-society consensus for the management of peripheral arterial disease. Eur J Vasc Endovasc Surg. 2007;33(Suppl 1):S1–S75. doi: 10.1016/j.ejvs.2006.09.024. - DOI - PubMed
    1. Wierzchowski P, Dereziński T, Migdalski A, Woda Ł, Wąsikowska B, Jakubowski G, et al. Cross-sectional study of the ankle– brachial index and cardiovascular risk factors in postmenopausal women. Kardiol Pol. 2017;75:486–494. doi: 10.5603/KP.a2017.0016. - DOI - PubMed
    1. Fowkes F, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382:1329–1340. doi: 10.1016/S0140-6736(13)61249-0. - DOI - PubMed
    1. Shishehbor MH, White CJ, Gray BH, Menard MT, Lookstein R, Rosenfield K, et al. Critical limb ischemia. An expert statement. J Am Coll Cardiol. 2016;68:2002–2015. doi: 10.1016/j.jacc.2016.04.071. - DOI - PubMed
    1. Varu VN, Hogg ME, Kibbe MR. Critical limb ischemia. J Vasc Surg. 2010;51:230–241. doi: 10.1016/j.jvs.2009.08.073. - DOI - PubMed