title: Potential mechanisms of in-stent occlusion in the femoropopliteal artery: an angioscopic assessment.
abstract: Although stent implantation has become widespread for the treatment of patients with peripheral artery disease with femoropopliteal (FP) lesions, in-stent restenosis, especially in-stent occlusion (ISO), remains as a major concern for refractory recurrence. Furthermore, the mechanisms of ISO in FP lesions have not been well elucidated. We performed angioscopy for 6 lesions (bare-metal stent: 3, drug-eluting stent: 3) from 5 patients (mean age 74 ± 10 years, male 40 %) with ISO in the FP artery immediately after wire-passing or thrombus aspiration. The presence of thrombus as well as the presence and location of organic stenosis were evaluated. Median duration from stent implantation to angioscopic evaluation was 1099.5 (514.5-2272.5) days, while the duration from recurrence of symptoms to angioscopic evaluation was 45 (5.75-60) days. Mixed thrombi were observed in all stents. Organic stenosis was detected at the proximal edge of the stents in 5 lesions. Organic stenosis was observed at the overlapping segment of the stent in one lesion. The distal edge of the stents could be evaluated in 3 lesions, and all of them showed organic stenosis at the site. Mixed thrombi and organic stenosis were observed in all stents. Partial development of organic stenosis in a stent followed by thrombus formation may be the potential mechanism of the development of ISO in the FP artery though the sample size of this study was small and it had no serial angioscopic data so that we should consider it as preliminary one at best.
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, 660-8511, Japan. t.ishihara31@gmail.com.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ishihara
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, 660-8511, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Iida
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, 660-8511, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Okamoto
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, 660-8511, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Fujita
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, 660-8511, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Masuda
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, 660-8511, Japan.
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Nanto
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, 660-8511, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Shiraki
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, 660-8511, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanda
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, 660-8511, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Tsujimura
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, 660-8511, Japan.
authors.forename: Shota
authors.initials: S
authors.lastname: Okuno
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, 660-8511, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Yanaka
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, 660-8511, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Uematsu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017546:Angioscopy; D005260:Female; D005263:Femoral Artery / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000601:surgery; D011150:Popliteal Artery / Q000473:pathology* / Q000601:surgery; D012008:Recurrence; D015607:Stents / Q000009:adverse effects*
keywords: Angioscopy; Femoropopliteal artery; In-stent occlusion