title: Safety and One-Year revascularization outcome of excimer laser ablation therapy in treating in-stent restenosis of femoropopliteal arteries: A retrospective review from a single center.
abstract: BACKGROUND
  Treatment of in-stent restenosis of the femoropopliteal (FP) arteries is challenging with a high rate of restenosis. Excimer laser atherectomy (ELA) has a theoretical advantage of ablating restenotic tissue and reducing or delaying the need for repeat revascularization. We present a retrospective analysis from our center on the outcomes of ELA in the treatment of in-stent restenosis of the FP arteries.
  
  
  METHODS
  Demographic, clinical, angiographic and procedural data were collected on all patients that underwent ELA for in-stent restenosis from February 2005 to April 2010 at a single medical center. Major adverse events and one-year target lesion revascularization (TLR) and target vessel revascularization (TVR) were obtained by reviewing of medical records. Descriptive analysis was performed on all variables. Kaplan-Meier survival curves for TLR were plotted.
  
  
  RESULTS
  40 consecutive patients (mean age 67.7±9.0years, 57.5% males) were included and followed for 1year. Adjunctive balloon angioplasty was performed in 100% at a mean pressure of 12.4±2.9atm. Acute procedural success (<30% angiographic residual narrowing) occurred in 92.5% of patients. Embolic filter protection (EFP) was used in 57.5% of patients. Bailout stenting was 50.0%. Macrodebris was noted in 65.2% of filters. The following adverse events were reported: distal embolization (DE) requiring treatment 2.5% (1 patient with no EFP); planned minor amputation 2.6%, planned major amputation 2.6%, total death 7.7% (all cardiac related). One perforation occurred treated successfully with stenting and balloon inflation. At one year, TLR and TVR occurred in 48.7% and 48.7% respectively.
  
  
  CONCLUSIONS
  ELA has an overall favorable acute result in treating in-stent restenosis of the FP arteries. At one year TLR and TVR remain clinically significant. DE also occurs significantly with ELA and is effectively prevented with EFP.
authors.affiliation: Midwest Cardiovascular Research Foundation, Davenport, IA 52722, USA. shammas@mchsi.com
authors.forename: Nicolas W
authors.initials: NW
authors.lastname: Shammas
authors.forename: Gail A
authors.initials: GA
authors.lastname: Shammas
authors.forename: Alexander
authors.initials: A
authors.lastname: Hafez
authors.forename: Ryan
authors.initials: R
authors.lastname: Kelly
authors.forename: Emily
authors.initials: E
authors.lastname: Reynolds
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Shammas
mesh_terms: D023903:Coronary Restenosis / Q000628:therapy*; D005263:Femoral Artery; D006801:Humans; D054018:Lasers, Excimer / Q000627:therapeutic use; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome