title: Neointimal hyperplasia after silverhawk atherectomy versus percutaneous transluminal angioplasty (PTA) in femoropopliteal stent reobstructions: a controlled, randomized pilot trial.
abstract: BACKGROUND
  Due to intimal hyperplasia instent reobstruction in the femoropopliteal arterial segment is still an unsolved problem. Different techniques have been discussed in case of reintervention to guarantee longlasting patency rate.
  
  
  METHODS
  We conducted a randomized, controlled, pilot trial comparing Silverhawk atherectomy with percutaneous transluminal angioplasty (PTA) in patients with a first instent reobstruction in the femoropopliteal arterial segment, to evaluate intima media thickness (IMT) within the treated segment, as a parameter of recurrence of intimal hyperplasia.
  
  
  RESULTS
  In a total 19 patients were included: 9 patients in the atherectomy device and 10 patients in the PTA arm. IMT within the treated segment was statistically significantly elevated in all patients treated with the Silverhawk device versus the patients treated with PTA. The obvious differentiation in elevation of IMT in nonfavor for patients treated with the Silverhawk device started at month 2 (max IMT SH 0.178 mm vs. IMT PTA 0.1 mm, p = 0.001) with a spike at month 5 (max IMT SH 0.206 mm vs. IMT PTA 0.145 mm, p = 0.003) and a decline once again at month 6 (max IMT SH 0.177 mm vs. IMT PTA 0.121 mm, p = 0.02). The values for mean IMT performed the same way.
  
  
  CONCLUSIONS
  Although Silverhawk atherectomy provides good results at first sight, in the midterm follow-up of treatment of first instent restenosis it did not perform better than PTA as it showed elevated reoccurrence of intimal media hyperplasia.
authors.affiliation: Division of Angiology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. marianne.brodmann@medunigraz.at
authors.forename: Marianne
authors.initials: M
authors.lastname: Brodmann
authors.forename: Peter
authors.initials: P
authors.lastname: Rief
authors.forename: Harald
authors.initials: H
authors.lastname: Froehlich
authors.forename: Andreas
authors.initials: A
authors.lastname: Dorr
authors.forename: Thomas
authors.initials: T
authors.lastname: Gary
authors.forename: Philipp
authors.initials: P
authors.lastname: Eller
authors.forename: Franz
authors.initials: F
authors.lastname: Hafner
authors.forename: Hannes
authors.initials: H
authors.lastname: Deutschmann
authors.forename: Gerald
authors.initials: G
authors.lastname: Seinost
authors.forename: Ernst
authors.initials: E
authors.lastname: Pilger
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods; D017130:Angioplasty / Q000295:instrumentation* / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D017073:Atherectomy / Q000009:adverse effects / Q000379:methods*; D003251:Constriction, Pathologic / Q000473:pathology / Q000628:therapy; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D058426:Neointima / Q000000981:diagnostic imaging / Q000473:pathology*; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D010865:Pilot Projects; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000473:pathology; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome