Stent remodeling contributes to femoropopliteal artery restenosis: an intravascular ultrasound study.
This case report describes the status of femoropopliteal artery stents after intervention documented with intravascular ultrasound compared with the changes seen at follow-up. To treat an extensive dissection after balloon angioplasty, a 57-year-old man underwent placement of seven adjacent Palmaz stents. At 5-month follow-up, an angiographic and intravascular ultrasound examination revealed four distinct stenotic lesions (> or = 50%) at stent junctions. Intravascular ultrasound images obtained during the initial stent placement were compared with the corresponding images obtained at follow-up. A distinction was made between changes seen at stent junctions and stent edges (n = 8), those seen within each stent (n = 7), and those in the nonstented sections proximally and distally (n = 3). Intravascular ultrasound examination established that both intimal hyperplasia and stent area reduction (stent remodeling) resulted in lumen area reduction. The extent of the changes seen at the stent junctions were greater than that of changes seen within the stents: lumen area reduction, 67% versus 23%; stent area reduction, 26% versus 11%; and intimal hyperplasia, 10.8 versus 3.3 mm2; respectively. Changes in the nonstented sections were minimal (< 2%). The stent edge seen at the adductor canal showed elliptical deformation. Thus there is a higher risk of restenosis at the stent junctions. In addition to intimal hyperplasia, stent remodeling contributes to restenosis.
van Lankeren
W
W
Department of Radiology, University Hospital Rotterdam-Dijkzigt, Erasmus University, The Netherlands.
Gussenhoven
E J
EJ
van Kints
M J
MJ
van der Lugt
A
A
van Sambeek
M R
MR
D000784:Aortic Dissection / Q000209:etiology / Q000628:therapy; D000800:Angioplasty, Balloon / Q000009:adverse effects; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia; D007383:Intermittent Claudication / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging*; D011859:Radiography; D012008:Recurrence; D012307:Risk Factors; D015607:Stents; D013499:Surface Properties; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology; D018084:Ultrasonography, Interventional