Drug-coated stent implantation vs. bypass surgery for in-stent occlusion after femoropopliteal stenting.
The optimal revascularization for in-stent occlusion (ISO) lesions after femoropopliteal (FP) bare-nitinol stenting has not been established. We, therefore, investigated the comparison between drug-coated stent (DCS) implantation and bypass surgery (BSX) for ISO lesions after FP bare-nitinol stenting. This study was a dual-center, observational study from January 2004 to December 2015. A total of 172 ISO lesions were observed, and after excluding 120 ISO lesions, 52 ISO lesions (50 patients; mean age, 71.0 ± 9.2 years; male, 59.6%) after FP bare-nitinol stenting were enrolled. The included patients with clinical symptoms underwent either DCS implantation (n = 28) or BSX (n = 22). The primary endpoint was recurrent in-stent restenosis (ReISR); secondary endpoints were recurrent target lesion revascularization (ReTLR), recurrent occlusion (reocclusion) and major adverse limb events (MALE), and perioperative complications (POCs), respectively. ReISR or reocclusion was defined as ISR or occlusion after TLR. Stent restenosis was defined as a peak systolic velocity ratio (PSVR) > 2.4 on a duplex scan or ≥ 50% stenosis on angiography. Graft restenosis was defined as a PSV > 300 cm/s and velocity ratio 3.5 or uniformly low PSV < 45 cm/s throughout the entire graft based on graft surveillance. The mean follow-up period was 36.6 ± 25.5 months. At 2 years, the rates of freedom from ReISR, ReTLR, and MALE were not significantly different between the DCS implantation and BSX groups (68.9% vs. 73.7%, p = 0.81; 84.7% vs. 73.7%, p = 0.45; 84.7% vs. 78.6%, p = 0.60, respectively). However, the freedom from reocclusion rate was significantly lower in the DCS implantation group (81.6% vs. 100%, p = 0.04). The occurrence of POCs was not significantly different between the DCS implantation and BSX groups (7.1% vs 4.2%, p = 1.0). Although BSX was the gold-standard therapy for ISO lesions after FP bare-nitinol stenting, DCS implantation might be a good option because the rates of freedom from ReISR, ReTLR, and MALE were similar.
['Tomoi|Yusuke|Y|http://orcid.org/0000-0002-8939-0222', 'Soga|Yoshimitsu|Y|', 'Okazaki|Jin|J|', 'Iida|Osamu|O|', 'Shiraki|Tatsuya|T|', 'Hiramori|Seiichi|S|', 'Ando|Kenji|K|']
D000368:Aged D000792:Angiography D054855:Drug-Eluting Stents D057510:Endovascular Procedures D005260:Female D005263:Femoral Artery D005500:Follow-Up Studies D006801:Humans D008297:Male D058729:Peripheral Arterial Disease D011150:Popliteal Artery D011474:Prosthesis Design D012189:Retrospective Studies D016896:Treatment Outcome D014654:Vascular Patency
Drug-coated stent Bypass surgery In-stent occlusion Endovascular therapy