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. 2022 Jul 15:2022:5935039.
doi: 10.1155/2022/5935039. eCollection 2022.

Endovascular Treatment and Outcomes for Femoropopliteal In-Stent Restenosis: Insights from the XLPAD Registry

Michael H Vu  1 , Glaiza-Mae Sande-Docor  2 , Yulun Liu  2 , Shirling Tsai  2   3 , Mitul Patel  4 , Chris Metzger  5 , Mehdi H Shishehbor  6 , Emmanouil S Brilakis  7 , Nicolas W Shammas  8 , Peter Monteleone  9 , Subhash Banerjee  2   3
Affiliations

Endovascular Treatment and Outcomes for Femoropopliteal In-Stent Restenosis: Insights from the XLPAD Registry

Michael H Vu et al. J Interv Cardiol. .

Abstract

Background: There is limited "real-world" evidence examining treatment modalities and outcomes in patients with symptomatic peripheral arterial disease undergoing endovascular treatment of femoropopliteal (FP) in-stent restenosis (ISR).

Materials and methods: We compared outcomes in 2,895 patients from the XLPAD registry (NCT01904851) between 2006 and 2019 treated for FP ISR (n = 347) and non-ISR (n = 2,548) lesions. Primary endpoint included major adverse limb events (MALE) at 1 year, a composite of all-cause death, target limb repeat revascularization, or major amputation.

Results: ISR patients were more frequently on antiplatelet (94.5% vs 89.4%, p=0.007) and statin (68.9% vs 60.3%, p=0.003) therapies. Lesion length was similar (ISR: 145 ± 99 mm vs. non-ISR: 142 ± 99 mm, p=0.55). Fewer treated ISR lesions were chronic total occlusions (47.3% vs. 53.7%, p=0.02) and severely calcified (22.4% vs. 44.7%, p < 0.001). Atherectomy (63.5% vs. 45.0%, p < 0.001) and drug-coated balloons (DCB; 4.7% vs. 1.7%, p < 0.001) were more frequently used in ISR lesions. The distal embolization rate was higher in ISR lesions (2.4% vs. 0.9%, p=0.02). Repeat revascularization (21.5% vs. 16.7%, p=0.04; Figure) was higher and freedom from MALE at 1 year was significantly lower (87% vs. 92.5%, p < 0.001) in the ISR group.

Conclusion: Atherectomy and DCB are more frequently used to treat FP ISR lesions. Patients with FP ISR have more intraprocedural distal embolization, higher repeat revascularization procedures, and lower freedom from MALE at 1 year.

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Conflict of interest statement

Mitul Patel, MD, has received consulting honoraria from Abbott Vascular, Medtronic, Cardiovascular Systems, Inc., and Chiesi. Research/Institutional grant support was obtained from Abiomed and Boston Scientific; Chris Metzger, MD, is nominal symposia/proctor at Abbott Vascular, Shockwave, Cardiovascular Systems, Inc., Penumbra; Mehdi H. Shishehbor, DO, MPH, PhD, has received Advisory Board/Consulting fees from Medtronic, Abbott Vascular, Phillips, Terumo, and Boston Scientific; Emmanouil S. Brilakis, MD, has received consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor circulation), Amgen, Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), ControlRad, CSI, Ebix, Elsevier, GE Healthcare, InfraRedx, Medtronic, Siemens, and Teleflex; research support was obtained from Regeneron and Siemens. Owner, Hippocrates LLC, shareholder: MHI Ventures; Nicolas W. Shammas, MD, has received consulting fees from Intact Vascular, Bards, and Boston Scientific. Research and Institutional Grants were obtained from Intact Vascular, Bard, Boston Scientific, Phillips; Peter Monteleone, MD, has received consulting fees from Medtronic and Biotronik. Institutional grant support was obtained from Medtronic and Abbott; Subhash Banerjee is consultant for Medtronic, Cordis, Kaneka, and Institutional research grants were obtained from Boston Scientific Corporation and Chiesi. The rest of the authors declare that there are no conflicts of interest regarding publication of this paper.

Figures

Figure 1
Figure 1
1-year major adverse limb events (MALE) and repeat revascularization for femoropopliteal (FP) non-in-stent restenosis and in-stent restenosis (ISR) groups.
Figure 2
Figure 2
Survival curves comparing patients with femoropopliteal (FP) opliteal in-stent restenosis (ISR) and without ISR receiving endovascular treatment for symptomatic peripheral arterial disease (PAD). Kaplan–Meier curves showing that patients with FP ISR did not have significantly lower freedom from MALE at 12 months (a). Survival from target limb revascularization was significantly lower in the FP ISR group (b).
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References

    1. Lin J. H., Brunson A., Romano P. S., Mell M. W., Humphries M. D. Endovascular-first treatment is associated with improved amputation-free survival in patients with critical limb ischemia. Circulation: Cardiovascular Quality and Outcomes . 2019;12(8) doi: 10.1161/CIRCOUTCOMES.118.005273.e005273 - DOI - PMC - PubMed
    1. Cheng C. P., Wilson N. M., Hallett R. L., Herfkens R. J., Taylor C. A. In Vivo MR angiographic quantification of axial and twisting deformations of the superficial femoral artery resulting from maximum hip and knee flexion. Journal of Vascular and Interventional Radiology . 2006;17(6):979–987. doi: 10.1097/01.RVI.0000220367.62137.E8. - DOI - PubMed
    1. Ho K. J., Owens C. D. Diagnosis, classification, and treatment of femoropopliteal artery in-stent restenosis. Journal of Vascular Surgery . 2017;65(2):545–557. doi: 10.1016/j.jvs.2016.09.031. - DOI - PubMed
    1. Singh G. D., Armstrong E. J., Laird J. R. Femoropopliteal in-stent restenosis: current treatment strategies. The Journal of Cardiovascular Surgery . 2014;55(3):325–33. - PubMed
    1. Zankar A., Brilakis E., Banerjee S. Use of embolic capture angioplasty for the treatment of occluded superficial femoral artery segments. The Journal of invasive cardiology . 2011;23(11):480–4. - PubMed

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