Long-Term Effectiveness of a Drug-Eluting Stent for Femoropopliteal In-Stent Restenosis: Subanalysis of the Zilver PTX Japan Post-Market Surveillance Study.
PURPOSE
To present a subgroup analysis of patients from a large real-world study evaluating the safety and effectiveness of the Zilver PTX drug-eluting stent (DES) for treating femoropopliteal in-stent restenosis (ISR).


MATERIALS AND METHODS
This study examined patients enrolled in the Zilver PTX Japan Post-Market Surveillance Study (ClinicalTrials.gov identifier NCT02254837), a prospective, multicenter registry of 904 symptomatic patients with 1082 femoropopliteal lesions treated with the DES at 95 institutions in Japan. Five-year outcomes, including mortality, stent radiography, freedom from target lesion revascularization (TLR), and clinical benefit, were evaluated for 177 patients (mean age 74.2±8.3 years; 118 men) with 204 ISR lesions treated with the Zilver DES. Over half of the patients (108, 61.0%) were diabetic. Mean lesion length was 17.8±10.4 cm, and a third (72, 35.3%) were total occlusions. Outcome measures were all-cause mortality, thrombosis, freedom from TLR, and clinical benefit, defined as freedom from persistent or deteriorating ischemic symptoms.


RESULTS
No device-related or procedure-related deaths or paclitaxel-related adverse events were reported. All-cause mortality was 25.1% at 5 years. Stent fracture was observed in 5 stents through 5 years. The 5-year rate of freedom from clinically-driven TLR was 73.4%, and the rate of clinical benefit was 63.6%. Improvement in Rutherford category and ankle-brachial index was sustained through 5 years.


CONCLUSION
The safety and effectiveness of the Zilver PTX stent for the treatment of femoropopliteal ISR lesions demonstrated that this device provides a favorable treatment option in this difficult-to-treat subgroup.
['Sugimoto|Masayuki|M|https://orcid.org/0000-0002-1712-4398', 'Komori|Kimihiro|K|https://orcid.org/0000-0001-8197-2589', 'Yokoi|Hiroyoshi|H|', 'Ohki|Takao|T|', 'Kichikawa|Kimihiko|K|', 'Nakamura|Masato|M|', 'Nanto|Shinsuke|S|', "O'Leary|Erin E|EE|", 'Lottes|Aaron E|AE|https://orcid.org/0000-0002-8534-7075', 'Saunders|Alan T|AT|', 'Dake|Michael D|MD|https://orcid.org/0000-0002-2817-0875']
D000368:Aged D000369:Aged, 80 and over D023903:Coronary Restenosis D054855:Drug-Eluting Stents D005263:Femoral Artery D006801:Humans D007564:Japan D008297:Male D017239:Paclitaxel D058729:Peripheral Arterial Disease D011150:Popliteal Artery D011446:Prospective Studies D015607:Stents D016896:Treatment Outcome D014654:Vascular Patency
drug-eluting stent in-stent restenosis mortality target lesion revascularization occlusion peripheral artery disease