The Characteristics of In-Stent Restenosis After Drug-Eluting Stent Implantation in Femoropopliteal Lesions and 1-Year Prognosis After Repeat Endovascular Therapy for These Lesions.
OBJECTIVE
This study sought to investigate the characteristics of in-stent restenosis (ISR) after drug-eluting stent (DES) implantation for femoropopliteal (FP) lesions, and to examine 1-year prognosis after repeat endovascular therapy (re-EVT) for these DES-ISR.


BACKGROUND
The morphology of DES-ISR and its association with clinical outcomes after re-EVT have not been well examined.


METHODS
This was a subanalysis of the ZEPHYR (Zilver PTX for the femoral artery and proximal popliteal artery) study. The current study included 210 cases with loss of patency confirmed 1 year after DES implantation. Morphology of DES-ISR was classified into the following subgroups: class I, focal lesions (≤50 mm in length), class II, diffuse lesions (>50 mm in length), and class III, totally occluded ISR. One-year prognosis after re-EVT for DES-ISR was assessed by restenosis and major adverse limb events (MALE).


RESULTS
Classes I, II, and III accounted for 50%, 25%, and 25% of DES-ISR, respectively. Factors associated with the morphology of DES-ISR were the presence of chronic total occlusion and the size of the external elastic membrane area before DES implantation (p = 0.009 and 0.017). Compared with the class I restenotic lesion, the class II and III lesions had a significantly higher risk of restenosis (74% and 78% vs. 53%: p = 0.048 and 0.019, respectively) and MALE (56% and 56% versus 32%: p = 0.025 and 0.022, respectively) 1 year after re-EVT.


CONCLUSIONS
We evaluated the characteristics of ISR after DES implantation for FP lesions and 1-year prognosis of re-EVT for DES-ISR. The morphology of DES-ISR had a significant association with 1-year prognosis after re-EVT.
Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan. Electronic address: iida.osa@gmail.com.
Osamu
O
Iida
Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Japan; Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Mitsuyoshi
M
Takahara
Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
Yoshimitsu
Y
Soga
Division of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama City, Japan.
Keisuke
K
Hirano
Cardiovascular Center, Kikuna Memorial Hospital, Yokohama City, Japan.
Yasutaka
Y
Yamauchi
Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Omihachiman, Japan.
Kan
K
Zen
Cardiovascular Division, Department of Internal Medicine, Morinomiya Hospital, Osaka, Japan.
Daizo
D
Kawasaki
Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, Suita, Japan.
Shinsuke
S
Nanto
Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka City, Japan.
Hiroyoshi
H
Yokoi
Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan.
Masaaki
M
Uematsu
D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic; D054855:Drug-Eluting Stents; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D007564:Japan; D008297:Male; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011446:Prospective Studies; D012008:Recurrence; D019233:Retreatment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
drug-eluting stent(s); femoropopliteal lesion; in-stent restenosis