Percutaneous mechanical atherothrombectomy using the Rotarex®S device in peripheral artery in-stent restenosis or occlusion: a French retrospective multicenter study on 128 patients

Introduction: The use of drug-coated balloons (DCB) is a promising technique to treat in-stent restenosis without adding another metal scaffold. Clinical non-inferiority of DCB for treatment of in-stent restenosis (ISR) has been demonstrated compared to drug eluting stents (DES) implantation. However, pathology of neointima treated by DCB remains unclear. Aim: Pathological study of neointima after DCB treatment for ISR has not been reported. This study aimed to examine the tissue response after DCB treatment and plain old balloon angioplasty (POBA) for ISR pathologically, by using atherosclerotic femoral artery of porcine model. Methods: Using micromini pigs fed high-cholesterol, high-fat diet for 3 months, we stented bare metal stents in femoral arteries. After one month of stenting, dilatation of in-stent region by using DCB, and non-compliance balloon (NCB) as POBA were performed. Optimal coherence tomography and angioscopy showed drug adhesion on luminal surface. One month after the balloon expansion, treated arteries were dissected and stent segments were fixed with 10% buffered formalin and embedded in plastic. Stents were segmented at 3mm intervals and histologic sections were prepared. The neointimal area and blood vessel area were morphometrically evaluated, and the ratio of neointimal area per blood vessel area was calculated. Additionally, number of cells per 1mm 2 neointimal area was counted with digital morphometry. Results: We compared the histology between DCB (n=3, 18 histological sections) and POBA (n=3, 18 histological sections) lesions. The ratio of neointimal area per blood vessel area treated by DCB was 0.17 ± 0.01, while that of POBA was 0.21 ± 0.01 (P value = 0.02) respectively. Additionally, the number of cells per 1mm 2 neointimal area was significantly less in the neointima dilated by DCB (1940.9 ± 150.9), compared to that dilated by NCB (2599.8 ± 190.3) (P value = 0.01). These results suggest that DCB treatment after ISR prevents neointimal thickening by inhibiting proliferation of smooth muscle cells. Conclusions: We examined the pathology of in-stent neointima dilated by DCB in peripheral artery of atherosclerotic porcine model. Pathological analysis showed suppressed neointimal proliferation after DCB compared to POBA.

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Peripheral stent technology and current status for endovascular treatment of femoropopliteal artery disease: a clinical review

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20181743 ◽

2018 ◽

Vol 6 (5) ◽

pp. 1474

Author(s):

Bhargav Dave ◽

Rikin Shah

Keyword(s):

Peripheral Artery Disease ◽

Current Status ◽

Stent Fracture ◽

Peripheral Artery ◽

Stent Restenosis ◽

Nitinol Stents ◽

Long Term Follow Up ◽

Drug Eluting ◽

Artery Disease ◽

In Stent Restenosis

Over the past decade, the treatment of peripheral artery disease poses a number of technical challenges for the physician. The primary rationale of this article is to review the available literature on the current practices involved in the treatment of peripheral artery disease (PAD), particularly the femoropopliteal lesions. It is evident from the landmark clinical trials that the use of self-expanding drug-eluting stents (DES) has become the most favored clinical strategy for treating peripheral lesions above the knee. It is chiefly due to higher patency rates, and minimal in-stent restenosis and stent fracture rates associated with the use of DES. The technical evolution in the endovascular approach from the use of bare nitinol stents to DES for treating PAD and the factors responsible for this transformation have also been reviewed with their respective justification. Presently there is a need of DES technology for the treatment of femoropopliteal lesions, which can reduce the risk of stent fracture and in-stent restenosis for longer lesions while maintaining patency during long-term follow-up. To conclude, this review establishes that self-expanding DES and drug coated balloons using anti-proliferative drugs like sirolimus and paclitaxel are currently the most effective method of treating the femoropopliteal lesions in PAD.

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TCT-274 A Prospective Multicenter Study to Assess the Long-Term Safety and Efficacy of Sirolimus-Coated Balloon in Treatment of In-Stent Restenosis in Unselected Real-World Patients

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2019.08.346 ◽

2019 ◽

Vol 74 (13) ◽

pp. B273

Author(s):

Azeem Latib ◽

Sameer Dani ◽

Keyur Parikh ◽

Prathrap Kumar ◽

Ranjan Shetty ◽

...

Keyword(s):

Multicenter Study ◽

Real World ◽

Prospective Multicenter Study ◽

Safety And Efficacy ◽

Stent Restenosis ◽

In Stent Restenosis

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MiR-140-3p is Involved in In-Stent Restenosis by Targeting C-Myb and BCL-2 in Peripheral Artery Disease

Journal of Atherosclerosis and Thrombosis ◽

10.5551/jat.44024 ◽

2018 ◽

Vol 25 (11) ◽

pp. 1168-1181 ◽

Cited By ~ 7

Author(s):

Zheng-Rong Zhu ◽

Qiong He ◽

Wei-Bin Wu ◽

Guang-Qi Chang ◽

Chen Yao ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Peripheral Artery ◽

Stent Restenosis ◽

Artery Disease ◽

In Stent Restenosis

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Inflammatory Cytokine Levels After Endovascular Therapy in Patients With Peripheral Artery Disease

Angiology ◽

10.1177/0003319716682122 ◽

2016 ◽

Vol 68 (8) ◽

pp. 734-740 ◽

Cited By ~ 2

Author(s):

Yasushi Ueki ◽

Takashi Miura ◽

Yusuke Miyashita ◽

Souichiro Ebisawa ◽

Hirohiko Motoki ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Endovascular Therapy ◽

Inflammatory Cytokine ◽

Enzyme Linked Immunosorbent Assay ◽

Peripheral Artery ◽

Stent Restenosis ◽

Tnf Α ◽

Cytokine Levels ◽

Artery Disease ◽

In Stent Restenosis

We evaluated the impact of endovascular therapy (EVT) on inflammatory cytokine levels and its relationship with in-stent restenosis in patients with peripheral artery disease. The study prospectively enrolled 35 patients with intermittent claudication who underwent EVT of the iliofemoral artery. Levels of interleukin 6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and tumor necrosis factor α (TNF-α) were measured using enzyme-linked immunosorbent assay before and at 2 hours, 4 hours, and 3 months after EVT. All cytokine levels increased significantly after EVT (IL-6 [pg/mL]: from 1.51 [0.84-1.93] before EVT to 6.97 [4.05-20.41] at 2 hours and 13.29 [4.57-31.88] at 4 hours; MCP-1 [pg/mL]: from 326.65 [265.60-406.55] before EVT to 411.18 [341.21-566.27] at 2 hours and 519.36 [383.58-644.85] at 4 hours; TNF-α [pg/mL]: from 1.08 [0.77-1.29] before EVT to 1.25 [0.94-1.81] at 2 hours and 1.27 [0.95-1.59] at 4 hours, all P < .001). However, cytokine levels did not differ significantly between lesions with and without in-stent restenosis. Overall, our results suggest that EVT significantly increases IL-6, MCP-1, and TNF-α levels in the ischemic leg, but this effect is not associated with a higher rate of in-stent restenosis.

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