Preoperative CT-scan-based sizing and in-stent restenosis in peripheral endovascular revascularizations

Vascular ◽  
2017 ◽  
Vol 25 (5) ◽  
pp. 504-513 ◽  
Author(s):  
Adrien Kaladji ◽  
Maximilien Giovannetti ◽  
Remy Pascot ◽  
Elodie Clochard ◽  
Anne Daoudal ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Ct Scan ◽  
De Novo ◽  
External Iliac Artery ◽  
Arterial Disease ◽  
Endovascular Procedure ◽  
Stent Restenosis ◽  
Preoperative Ct ◽  
Peripheral Arterial ◽  
The Ideal

Objectives This study evaluates the effect of stent sizing with CT-scan on the incidence of restenosis in peripheral arterial disease. Methods This retrospective study included 59 patients with 66 arterial lesions who underwent a endovascular procedure for peripheral arterial disease between April 2013 and October 2013. All patients had de novo iliac or femoral lesions, were candidates for an endovascular procedure alone and underwent CTA preoperatively. The stent actually implanted, whose dimensions were chosen on the basis of the operator’s experience on an intraoperative 2D angiography, was compared to the “ideal” stent chosen retrospectively on the basis of precise lesion sizing by the preoperative CTA. Planning was considered “discordant” if there was a difference in length of more than 20 mm and/or a difference in diameter of more than 1 mm between the ideal stent and the actual stent. Results For iliac lesions, discordance essentially concerned stent diameter (36.1%), whereas stent length was the main reason for discordance for femoral lesions (36.7%). The median length of follow-up was 18 months (range 6–24). For iliac lesions, freedom from restenosis at 24 months was higher for patients with concordant planning (90% vs. 62.5%, p = 0.045). Most restenoses occurred in the external iliac artery, where there was a tendency towards oversizing of the implanted stent. For femoral lesions, the restenosis-free rate at 24 months was higher for patients with concordant planning (77.8% vs. 50%, p = 0.057). A multivariate analysis was conducted on the prediction of restenosis. Among factors, only discordant planning was found to be a significant predictor of restenosis with an odds ratio of 0.115 (95% confidence interval, 0.02–0.674; p = 0.016). Conclusion The absence of sizing for peripheral lesions engenders a tendency to choose the wrong stent, in particular in terms of diameter in iliac arteries and length in femoral arteries.

Abstract 288: Role of Cilostazol in Preventing Instent Restenosis Among Patients With Peripheral Arterial Disease: A Meta-analysis

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Omer Iftikhar ◽  
Karla Oliveros ◽  
Alfonso Tafur ◽  
Ana Casanegra
Keyword(s):  
Peripheral Arterial Disease ◽  
Odds Ratio ◽  
Random Effect ◽  
Random Effect Model ◽  
Arterial Disease ◽  
Primary Patency ◽  
Stent Restenosis ◽  
Number Of Patients ◽  
Peripheral Arterial ◽  
In Stent Restenosis

Objective: Peripheral arterial disease (PAD) is associated with two to six fold increase in the cardiovascular mortality. Revascularization is indicated to relieve life limiting ischemic symptoms and improve wound healing. Primary patency for balloon angioplasty has been reported to be around 40 to 60% in the first year[8]. Stents have improved rates of primary patency but long-term patency rates are not comparable to bypass surgery, with many patients at high risk of in-stent restenosis. Many adjunctive therapies have been proposed to reduce the high restenosis rate. Our aim is to evaluate the use of cilostazol to prevent in-stent restenosis among patients with lower extremity arterial stenting. Methods: We performed a MEDLINE and EMBASE search, and reviewed the abstracts and manuscripts following the PRISMA guidelines. Patency rate after stenting was the primary efficacy outcome. At least 2 abstractors reviewed the study list and selected manuscripts. We calculated Q statistic and a homogeneity formal test. The odds ratio (OR) estimates were pooled by using the Mantel-Haenszel random-effects method. Data were analyzed using the R META package Results: We identified 524 studies, 20 articles were fully abstracted and 4 included in the metaanalysis. The total number of patients was 2434. The cilostazol and control groups were evenly divided. All studies were of moderate quality. Clinical characteristics including age and BMI were similar in the two groups. Stents were placed to treat de novo lesions. Two of the studies compared cilostazol to ticlopidine. Cilostazol group patients had better primary patency rates after endovascular therapy than patients not taking cilostazol (OR 0.55, 95% CI 0.43 - 0.71). Heterogeneity was moderate with I2 of 38% and of moderate clinical relevance not statistically significant thus random effect model was kept. Omitting a single study did not affect the overall odds ratio of the other studies. Funnel plot suggested no publication bias. Conclusions: In stent stenosis among revascularized patients with PAD was 45% lower for patients who were on cilostazol.

scholarly journals Treatment strategies for in-stent restenosis in peripheral arterial disease: a systematic review

2018 ◽  
Vol 28 (2) ◽  
pp. 253-261 ◽  
Author(s):  
Shahab Hajibandeh ◽  
Shahin Hajibandeh ◽  
Stavros A Antoniou ◽  
Francesco Torella ◽  
George A Antoniou
Keyword(s):  
Systematic Review ◽  
Peripheral Arterial Disease ◽  
Treatment Strategies ◽  
Arterial Disease ◽  
Stent Restenosis ◽  
Peripheral Arterial ◽  
In Stent Restenosis

scholarly journals Brief Review of Options to Treat In-stent Restenosis of Femoro-popliteal Artery

2021 ◽  
Keyword(s):  
Peripheral Arterial Disease ◽  
Popliteal Artery ◽  
Arterial Disease ◽  
Stent Restenosis ◽  
The World ◽  
Peripheral Arterial ◽  
In Stent Restenosis

Peripheral arterial disease (PAD) is affecting millions of people all around the world. The different kind of stents to treat PAD has been in use from last couple of decades. In-stent restenosis is common problem, faced by endovascular specialists that is still challenging to treat. In this article, we reviewed the different options available to treat in-stent restenosis of the femoral-popliteal artery.

Arterial Preparation by Longitudinal Micro-Incisions Before Balloon Angioplasty of the Superficial Femoral and Popliteal Artery: Acute and 12-Month Results

2021 ◽  
pp. 152660282110570
Author(s):  
Jean-Baptiste Dexpert ◽  
Daniel Hayoz ◽  
Rolf P. Engelberger ◽  
Caroline Krieger ◽  
Marie-Antoinette Rey Meyer ◽  
...  
Keyword(s):  
De Novo ◽  
Arterial Disease ◽  
Target Lesion ◽  
Transluminal Angioplasty ◽  
Target Lesion Revascularization ◽  
Lesion Length ◽  
Stent Restenosis ◽  
Stent Length ◽  
Peripheral Arterial ◽  
Vessel Preparation

Purpose: Percutaneous transluminal angioplasty (PTA) with conventional plain old balloon (POBA) and/or drug-coated balloon (DCB) is the primary intervention to treat peripheral artery stenoses. However, acute dissections during the procedure and potential for future target lesion revascularization remain procedural complications. The purpose of this study was to assess the acute and 12-month outcomes in patients who underwent novel vessel preparation with longitudinal, controlled-depth micro-incisions prior to PTA. Materials and Methods: Patients with symptomatic lower extremity peripheral arterial disease with a Rutherford class of 2 to 6 and >70% de novo stenosis of the superficial femoral or popliteal arteries were included in this retrospective study. Patients with thrombotic or embolic lesions, restenosis, or in-stent restenosis were excluded. The FLEX Vessel Prep System (FLEX VP) was used to prepare the vessel prior to PTA by creating micro-incisions at the target lesion. The FLEX VP was followed by POBA or paclitaxel DCB. Results: The study included 65 patients. Lesion characteristics were 90% median stenosis (range = 70%–100%), 75.4% mild-to-severe calcifications, and 33.8% occlusion rate, and median lesion length was 196 (range = 10–480) mm. Following vessel preparation, 82.1% of the patients had low severity dissection or no flow-limiting dissection. The provisional stent rate postprocedure was 16.9%, with a median stent length of 60 mm. The freedom from target lesion revascularization (FFTLR) in 63 evaluable patients at 6 and 12 months was 98.4% and 93.7%, respectively. Freedom from amputation was 100%. Conclusion: In this real-world/all-comers patient population with long, stenotic lesions across the calcification spectrum, vessel preparation with longitudinal micro-incisions prior to PTA was associated with low dissection rate, low dissection severity, low stent implantation, and high FFTLR with the absence of amputation at 12 months relative to published reports in long-lesion cohorts. These results support vessel preparation via micro-incisions.

Management of Peripheral Arterial Disease

2006 ◽  
Vol 39 (3) ◽  
pp. 44
Author(s):  
WILLIAM E. GOLDEN ◽  
ROBERT H. HOPKINS
Keyword(s):  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Peripheral Arterial
Sign in / Sign up

Export Citation Format

Share Document