title: Laser Atherectomy for Treatment of Femoropopliteal In-Stent Restenosis.
abstract: OBJECTIVE
  To investigate if laser atherectomy with adjunctive balloon angioplasty can improve endovascular treatment outcomes for femoropopliteal in-stent restenosis (ISR).
  
  
  METHODS
  A dual center study included 135 symptomatic patients (mean age 71 years; 76 men) who underwent endovascular treatment of femoropopliteal ISR between 2006 and 2013. Of these, 54 (40%) were treated with laser atherectomy and the remaining 81 patients with balloon angioplasty alone. Angiographic images were reviewed for lesion morphology and characteristics, TransAtlantic InterSociety Consensus (TASC) II classification, and distal runoff. Class I ISR was defined as focal lesions ≤50 mm, class II ISR as lesions >50 mm, and class III ISR as stent total occlusion. Recurrent ISR was determined by a peak systolic velocity ratio >2.4 by duplex ultrasound.
  
  
  RESULTS
  Patients treated with laser atherectomy had longer mean ISR lesion length (222 vs 114 mm, p<0.001) and more class III ISR (69% vs 20%, p=0.001). There was no association between laser atherectomy and rates of recurrent restenosis or occlusion for patients with class I/II ISR, but there was a significantly lower rate of target lesion revascularization at 2 years among patients treated with laser atherectomy (14% vs 44%, p=0.05). In comparison, patients with class III ISR treated with laser atherectomy had lower rates of recurrent restenosis at 1 year (54% vs 91%, p=0.05) and 2 years (69% vs 100%, p=0.05). Patients with class III ISR treated with laser atherectomy also had lower rates of recurrent in-stent occlusion at 2-year follow-up (33% vs 71%, p=0.04).
  
  
  CONCLUSIONS
  When used to treat complex ISR, including in-stent occlusions, laser atherectomy with adjunctive balloon angioplasty may be associated with improved patency.
authors.affiliation: Section of Cardiology, VA Eastern Colorado Healthcare System and University of Colorado School of Medicine, Denver, CO, USA.
authors.forename: Ehrin J
authors.initials: EJ
authors.lastname: Armstrong
authors.affiliation: Section of Cardiology, VA Eastern Colorado Healthcare System and University of Colorado School of Medicine, Denver, CO, USA.
authors.forename: Thejasvi
authors.initials: T
authors.lastname: Thiruvoipati
authors.affiliation: Section of Cardiology, VA Eastern Colorado Healthcare System and University of Colorado School of Medicine, Denver, CO, USA.
authors.forename: Kundai
authors.initials: K
authors.lastname: Tanganyika
authors.affiliation: Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis Medical Center, Sacramento, CA, USA.
authors.forename: Gagan D
authors.initials: GD
authors.lastname: Singh
authors.affiliation: Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis Medical Center, Sacramento, CA, USA john.laird@ucdmc.ucdavis.edu.
authors.forename: John R
authors.initials: JR
authors.lastname: Laird
mesh_terms: D000368:Aged; D000792:Angiography; D000800:Angioplasty, Balloon; D055109:Ankle Brachial Index; D017073:Atherectomy / Q000379:methods*; D001783:Blood Flow Velocity; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
keywords: balloon angioplasty; in-stent restenosis; laser atherectomy; patency; peripheral artery disease; reocclusion; stent; superficial femoral artery; target lesion revascularization