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
. 2021 Sep 1;28(9):954-962.
doi: 10.5551/jat.59774. Epub 2020 Oct 23.

Outcomes of Dissection Angles as Predictor of Restenosis after Drug-Coated Balloon Treatment

Amane Kozuki  1 , Mitsuyoshi Takahara  2 , Masahiro Shimizu  1 , Yoichi Kijima  1 , Ryoji Nagoshi  1 , Ryudo Fujiwara  1 , Hiroyuki Shibata  1 , Atsushi Suzuki  1 , Fumitaka Soga  1 , Tomohiro Miyata  1 , Yuki Sakamoto  1 , Hidenobu Seo  1 , Hiroyuki Asada  1 , Kouhei Isawa  1 , Kotaro Higuchi  1 , Junya Shite  1
Affiliations

Outcomes of Dissection Angles as Predictor of Restenosis after Drug-Coated Balloon Treatment

Amane Kozuki et al. J Atheroscler Thromb. .

Abstract

Aim: The predictors of restenosis after endovascular therapy (EVT) with paclitaxel drug-coated balloons (DCBs) have not been clearly established. The present study aimed to investigate the association of post-procedural dissection, as evaluated using intravascular ultrasound (IVUS), with the risk of restenosis following femoropopliteal EVT with paclitaxel DCBs.

Methods: In the present single-center retrospective study, 60 de novo femoropopliteal lesions (44 patients) that underwent EVT with DCBs, without bail-out stenting, were enrolled. The primary outcome was 1-year primary patency. Risk factors for restenosis were evaluated using a Cox proportional hazards regression model and random survival forest analysis.

Results: The 1-year primary patency rate was 57.2% [95% confidence interval, 45%-72%]. IVUS-evaluated post-procedural dissection was significantly associated with the risk of restenosis (P=0.002), with the best cutoff point of 64º [range, 39º-83º]. The random survival forest analysis showed that the variable importance measure of IVUS-evaluated dissection was significantly lower than that of the reference vessel diameter (P＜0.001), not different from that of the lesion length (P=0.41), and significantly higher than that of any other clinical feature (all P＜0.05).

Conclusion: IVUS-evaluated post-procedural dissection was associated with 1-year restenosis following femoropopliteal EVT with DCB.

Keywords: Dissection; Drug-coated balloon; Intravascular ultrasound; Peripheral artery disease; Restenosis.

PubMed Disclaimer

Figures

Fig.1. A representative case
Fig.1. A representative case
(a). Pre angiography (b) Post Paclitaxel DCB treatment angiography. The maximum dissection site is indicated with blue arrow and minimal lumen area site in red arrow (c) IVUS image and measurement of maximum dissection (blue arrow in panel b) (d) IVUS image and measurement of minimal lumen area (red arrow in panel b). DCB, drug-coated balloon; IVUS, intravascular ultrasound
Fig.2. IVUS-evaluated dissection and restenosis risk
Fig.2. IVUS-evaluated dissection and restenosis risk
(a) Histogram of IVUS-evaluated dissection. (b) Kaplan–Meier estimates of primary patency rate. (c) Association of IVUS-evaluated dissection with restenosis risk. (d) Sensitivity and specificity for 1-year restenosis risk corresponding to the respective cutoff points of IVUS-evaluated dissection. Shaded areas in panels c and d indicate 95% confidence intervals. IVUS, intravascular ultrasound
Fig.3. Variable importance in the random survival forest analysis
Fig.3. Variable importance in the random survival forest analysis
Error bars indicate 95% confidence intervals. IVUS, intravascular intrasound; TASC, TransAtlantic Inter-Society Consensus; PACSS, peripheral artery calcification scoring system; P2Y12, platelet adenosine diphosphate receptor
See this image and copyright information in PMC

References

    1. Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, Normat PE, Sampson UK, Williams LJ, Mensah GA, and Criqui MH: 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 - PubMed
    1. Ko T, Higashitani M, Uemura Y, Utsunomiya M, Yamaguchi T, Matsui A, Ozaki S, Tobita K, Kodama T, Morita H, and Komuro I: Clinical outcome and diverse risk factors for different therapeutic target locations of peripheral artery disease. J Atheroscler Thromb, 2020; 27: 769-779 - PMC - PubMed
    1. Abola MTB, Golledge J, Miyata T, Rha S-W, Yan BP, Dy TC, Ganzon MSV, Handa PK, Harris S, Zhisheng J, Pinjala R, Robless PA, Yokoi H, Alajar EB, Bermudez-Delos Santos AA, Llanes EJB, Obrado-Nabablit GM, Pestaño NS, Punzalan FE, and Tumanan-Mendoza B: Asia-Pacific Consensus Statement on the Management of Peripheral Artery Disease: A Report from the Asian Pacific Society of Atherosclerosis and Vascular Disease Asia-Pacific Peripheral Artery Disease Consensus Statement Project Committee. J Atheroscler Thromb, 2020; 27: 809-907 - PMC - PubMed
    1. Takahara M, Iida O, Kohsaka S, Soga Y, Fujihara M, Shinke T, Amano T, Ikari Y, J-EVT and J-PCI investigators: Presentation pattern of lower extremity endovascular intervention versus percutaneous coronary intervention. J Atheroscler Thromb, 2020; 27: 761-768 - PMC - PubMed
    1. Feldman DN, Armstrong EJ, Aronow HD, Gigliotti OS, Jaff MR, Klein AJ, Parikh SA, Prasad A, Rosenfield K, Shishehbor MH, Swaminathan RV, and White CJ: SCAI consensus guidelines for device selection in femoral-popliteal arterial interventions. Catheter Cardiovasc Interv, 2018; 92: 124-140 - PubMed