title: Strecker stents in the femoropopliteal arteries: value of duplex ultrasonography in restenosis assessment.
abstract: OBJECTIVE
  Experience with Strecker stent implantation in the femoropopliteal arteries has been described; however, few of the reports were prospective studies, and none routinely used site-specific assessment methods for follow-up evaluation of stent patency. The purpose of this study was to evaluate 1-year Strecker stent patency using duplex ultrasound imaging to obtain a more precise delineation of stent restenosis than is possible with other noninvasive assessment modalities.
  
  
  METHODS
  A prospective study involved 52 patients with 57 sites treated by angioplasty and Strecker stent deployment in the femoropopliteal arteries. Assessment included clinical evaluation; ankle-brachial index (ABI) measurements at rest and after exercise; and duplex ultrasound imaging preprocedurally and at 3 and 12 months after the intervention.
  
  
  RESULTS
  All 74 stents were deployed successfully in the 35 occluded arteries and 22 stenotic lesions. Acute reocclusion occurred in 6 (10%). At 3 months, primary patency was 81% and secondary patency 84%. Mean ( +/- SD) ABIs increased from 0.64 +/- 0.15 at rest and 0.32 +/- 0.17 after exercise to 0.89 +/- 0.14 and 0.68 +/- 0.23, respectively (p < 0.0001). At 12 months, primary patency was 79%, and secondary patency was 82%. Mean ABIs were 0.82 +/- 0.15 at rest and 0.52 +/- 0.22 after exercise at 12 months (p < 0.0002 compared with preprocedural ABIs). Analysis of the length of lesion treated showed betted results with shorter diseased segments, but this was not statistically significant (p > 0.05). Better outcomes were also obtained when one stent was used rather than two stents at 12 months (p = 0.15), but there was no difference at 3 months (p = 0.3). Thirty-four percent of the stented segments progressed from < 20% stenosis at 3 months to > 50% stenosis at 12 months. Overall, 19 (43%) of 44 segments progressed from < 50% stenosis at 3 months to a > 50% stenosis at 12 months. Restenosis seen at 3 months generally was in the native artery just proximal or distal to the stent, but at 12 months, restenosis was mainly inside the stent.
  
  
  CONCLUSIONS
  Strecker stents at 1-year demonstrated satisfactory patency in the femoropopliteal arteries when deployed for angioplasty salvage or recurrent disease. The 3- and 12-month evaluations obtained with duplex ultrasound provided site-specific hemodynamic data for stent assessment. Resting ankle pressures were a poor index of restenosis.
authors.affiliation: Cardio-Vascular Centre, Newcastle, New South Wales, Australia.
authors.forename: A E
authors.initials: AE
authors.lastname: Bray
authors.forename: W G
authors.initials: WG
authors.lastname: Liu
authors.forename: W A
authors.initials: WA
authors.lastname: Lewis
authors.forename: C
authors.initials: C
authors.lastname: Harrison
authors.forename: A
authors.initials: A
authors.lastname: Maullin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D001161:Arteriosclerosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D003251:Constriction, Pathologic; D018450:Disease Progression; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012008:Recurrence; D015607:Stents; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency