title: High plasma heparin cofactor II activity protects from restenosis after femoropopliteal stenting.
abstract: High heparin cofactor II (HCII) activity has recently been described to protect from coronary instent restenosis, presumably by inactivating thrombin in injured arteries. In this study, we investigated the association of HCII activity and restenosis after femoropopliteal stenting. We studied 63 consecutive patients with peripheral artery disease who underwent femoropopliteal stent implantation after initial failure of plain balloon angioplasty due to a significant residual stenosis (>30% lumen diameter reduction) or a flow limiting dissection. HCII activity was measured before stenting and patients were followed for median 10 months (interquartile range 6 to 17) for the occurrence of a first instent restenosis, defined as a >50% lumen diameter reduction by color coded duplex sonography and confirmed by angiography. Cumulative freedom from restenosis at 6 and 12 months in patients with lower HCII activity (100%, lower tertile, n=20) was 84% and 35% as compared to 93% and 72% in patients with high HCII activity (>100%, middle and upper tertile, n=43; p=0.024 by Log Rank test). Adjusting for the material of the implanted stents (nitinol vs. Wallstents), patients with a high HCII activity had a 0.39-fold reduced risk for instent restenosis (95% CI 0.17 to 0.90, p=0.028), additional adjustment for diabetes mellitus, poor run-off, critical limb ischemia and cumulative length of the stented segment did not alter the observed effect. Higher activity of heparin cofactor II may exert a protective effect against instent restenosis also in the femoropopliteal vessel area, confirming a prior observation after coronary stenting.
authors.affiliation: Department of Angiology, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. martin.schillinger@meduniwien.ac.at
authors.forename: Martin
authors.initials: M
authors.lastname: Schillinger
authors.forename: Markus
authors.initials: M
authors.lastname: Exner
authors.forename: Schila
authors.initials: S
authors.lastname: Sabeti
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Mlekusch
authors.forename: Jasmin
authors.initials: J
authors.lastname: Amighi
authors.forename: Sylvia
authors.initials: S
authors.lastname: Handler
authors.forename: Peter
authors.initials: P
authors.lastname: Quehenberger
authors.forename: Neda
authors.initials: N
authors.lastname: Kalifeh
authors.forename: Oswald
authors.initials: O
authors.lastname: Wagner
authors.forename: Erich
authors.initials: E
authors.lastname: Minar
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000601:surgery*; D015331:Cohort Studies; D023903:Coronary Restenosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D015844:Heparin Cofactor II / Q000032:analysis / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*
chemical_list: D015844:Heparin Cofactor II