title: Intravascular Ultrasound-Derived Stent Dimensions as Predictors of Angiographic Restenosis Following Nitinol Stent Implantation in the Superficial Femoral Artery.
abstract: OBJECTIVE
  To identify intravascular ultrasound (IVUS) measurements that can predict angiographic in-stent restenosis (ISR) following nitinol stent implantation in superficial femoral artery (SFA) lesions.
  
  
  METHODS
  A retrospective review was conducted of 97 patients (mean age 72.9±8.9 years; 63 men) who underwent IVUS examination during endovascular treatment of 112 de novo SFA lesions between July 2012 and December 2014. Self-expanding bare stents were implanted in 46 lesions and paclitaxel-eluting stents in 39 lesions. Six months after stenting, follow-up angiography was conducted to assess stent patency. The primary endpoint was angiographic ISR determined by quantitative vascular angiography analysis at the 6-month follow-up. Variables associated with restenosis were sought in multivariate analysis; the results are presented as the odds ratio (OR) and 95% confidence interval (CI).
  
  
  RESULTS
  At follow-up, 27 (31.8%) angiographic ISR lesions were recorded. The lesions treated with uncoated stents were more prevalent in the ISR group compared with the no restenosis group (74.1% vs 44.8%, p=0.02). Lesion length was longer (154.4±79.5 vs 109.0±89.3 mm, p=0.03) and postprocedure minimum stent area (MSA) measured by IVUS was smaller (13.9±2.8 vs 16.3±1.6 mm(2), p<0.001) in the ISR group. Multivariate analysis revealed that bare stent use (OR 7.11, 95% CI 1.70 to 29.80, p<0.01) and longer lesion length (OR 1.08, 95% CI 1.01 to 1.16, p=0.04) were predictors of ISR, while increasing postprocedure MSA (OR 0.58, 95% CI 0.41 to 0.82, p<0.01) was associated with lower risk of ISR. Receiver operating characteristic analysis identified a MSA of 15.5 mm(2) as the optimal cutpoint below which the incidence of restenosis increased (area under the curve 0.769).
  
  
  CONCLUSIONS
  Postprocedure MSA can predict ISR in SFA lesions, which suggests that adequate stent enlargement during angioplasty might be required for superior patency.
authors.affiliation: Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Miki
authors.affiliation: Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan kfujii@hyo-med.ac.jp.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Fujii
authors.affiliation: Cardiovascular Center, Morinomiya Hospital, Osaka, Japan.
authors.forename: Daizo
authors.initials: D
authors.lastname: Kawasaki
authors.affiliation: Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Shibuya
authors.affiliation: Cardiovascular Center, Morinomiya Hospital, Osaka, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Fukunaga
authors.affiliation: Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Imanaka
authors.affiliation: Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Tamaru
authors.affiliation: Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Sumiyoshi
authors.affiliation: Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Machiko
authors.initials: M
authors.lastname: Nishimura
authors.affiliation: Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Horimatsu
authors.affiliation: Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Ten
authors.initials: T
authors.lastname: Saita
authors.affiliation: Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Kozo
authors.initials: K
authors.lastname: Okada
authors.affiliation: Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Takumi
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Honda
authors.affiliation: Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Fitzgerald
authors.affiliation: Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Masuyama
authors.affiliation: Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ishihara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D000792:Angiography; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D019540:Area Under Curve; D002317:Cardiovascular Agents / Q000008:administration & dosage; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D054855:Drug-Eluting Stents; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017239:Paclitaxel / Q000008:administration & dosage; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012372:ROC Curve; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014654:Vascular Patency
chemical_list: D000497:Alloys; D002317:Cardiovascular Agents; C013616:nitinol; D017239:Paclitaxel
keywords: angioplasty; drug-eluting stent; endovascular therapy; in-stent restenosis; intravascular ultrasound; minimum stent area; peripheral artery disease; restenosis; self-expanding nitinol stent; superficial femoral artery