title: Histopathological Evidence of Adventitial or Medial Injury Is a Strong Predictor of Restenosis During Directional Atherectomy for Peripheral Artery Disease.
abstract: OBJECTIVE
  To investigate the impact on restenosis rates of deep injury to the adventitial layer during directional atherectomy.
  
  
  METHODS
  Between 2007 and 2010, 116 consecutive patients (mean age 69.6 years; 56 men) with symptomatic femoropopliteal stenoses were treated with directional atherectomy at a single center. All patients had claudication and TASC A/B lesions in the superficial femoral or popliteal arteries. Histopathology analysis of atherectomy specimens was performed to identify adventitial injury. Clinical follow-up included physical examination and duplex ultrasound scans at 3, 6, and 12 months in all patients. The primary endpoint was the duplex-documented 1-year rate of restenosis, which was determined by a peak systolic velocity ratio <2.4. Patients were dichotomized by the presence or absence of adventitial or medial cuts as evaluated by histopathology.
  
  
  RESULTS
  Adventitial injury were identified in 62 (53%) of patients. There were no differences in baseline demographic and clinical features (p>0.05), lesion length (58.7±12.8 vs 56.2±13.6 mm, p=0.40), or vessel runoff (1.9±0.6 vs 2.0±0.6, p=0.37) between patients with and without adventitial injury, respectively. The overall 1-year incidence of restenosis was 57%, but the rate was significantly higher (p<0.0001) in patients with adventitial or medial injury (97%, 60/62) as compared with those without (11%, 6/54).
  
  
  CONCLUSIONS
  Lack of adventitial injury after atherectomy for femoropopliteal stenosis is strongly related to patency at 1 year.
authors.affiliation: Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Arthur
authors.initials: A
authors.lastname: Tarricone
authors.affiliation: Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY, USA.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Ali
authors.affiliation: Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Anitha
authors.initials: A
authors.lastname: Rajamanickam
authors.affiliation: Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Karthik
authors.initials: K
authors.lastname: Gujja
authors.affiliation: Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Vishal
authors.initials: V
authors.lastname: Kapur
authors.affiliation: Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: K-Raman
authors.initials: KR
authors.lastname: Purushothaman
authors.affiliation: Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Meerarani
authors.initials: M
authors.lastname: Purushothaman
authors.affiliation: Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Miguel
authors.initials: M
authors.lastname: Vasquez
authors.affiliation: Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY, USA.
authors.forename: Adrian
authors.initials: A
authors.lastname: Zalewski
authors.affiliation: Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Micheal
authors.initials: M
authors.lastname: Parides
authors.affiliation: Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Overbey
authors.affiliation: Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Wiley
authors.affiliation: Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA prakash.krishnan@mountsinai.org.
authors.forename: Prakash
authors.initials: P
authors.lastname: Krishnan
mesh_terms: D063194:Adventitia / Q000293:injuries* / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D017073:Atherectomy / Q000009:adverse effects*; D003251:Constriction, Pathologic; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology / Q000503:physiopathology; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D017540:Tunica Media / Q000293:injuries* / Q000473:pathology; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology
keywords: adventitia; atherectomy; media layer; peripheral artery disease; plaque; restenosis; vessel injury