title: Incidence and its characteristics of repetition of reintervention after drug-eluting stent implantation for femoropopliteal lesion.
abstract: OBJECTIVE
  Although clinical trials demonstrated the superiority of the Zilver (Cook Medical, Bloomington, Ind) paclitaxel-eluting stent (PTX), a recently developed drug-eluting stent (DES), to conventional therapy for femoropopliteal (FP) lesions, the incidence and risk factors of the repetition of reintervention after DES implantation in clinical practice remained unrevealed.
  
  
  METHODS
  This was a subanalysis of the ZEPHYR (ZilvEr PTX for tHe Femoral ArterY and Proximal Popliteal ArteRy) study, enrolling FP lesions undergoing endovascular therapy (EVT) with DES implantation. The current study analyzed the 2-year database including 583 FP lesions in 495 patients undergoing preoperative intravascular ultrasound imaging before DES implantation. The primary outcome measure was re-re-EVT, defined as undergoing additional EVT more than once during the 2-year follow-up after DES implantation. The secondary outcome measure was re-EVT, defined as undergoing at least one additional EVT during the follow-up.
  
  
  RESULTS
  Critical limb ischemia (CLI) was present in 28% of the study population, 23% had a history of EVT, and 43% had chronic total occlusion. Mean lesion length was 16 ± 10 cm, and intravascular ultrasound imaging-evaluated external elastic membrane area was 28 ± 10 mm2. The cumulative incidence rate of re-re-EVT at 2 years was estimated to be 14%, whereas that of re-EVT was 31%. After multivariate analysis, CLI and smaller external elastic membrane area were independently associated with the outcome.
  
  
  CONCLUSIONS
  The incidence and risk factors of the repetition of reintervention after DES implantation for FP lesions were revealed. The current findings suggest that DES implantation might be a careful indication in CLI cases especially with a small vessel.
authors: Cardiovascular Center, Kansai Rosai Hospital, Hoyogo, Japan. Electronic address: iida.osa@gmail.com.
authors: Osamu
authors: O
authors: Iida
authors: Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Mitsuyoshi
authors: M
authors: Takahara
authors: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors: Yoshimitsu
authors: Y
authors: Soga
authors: Division of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama, Japan.
authors: Keisuke
authors: K
authors: Hirano
authors: Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan.
authors: Yasutaka
authors: Y
authors: Yamauchi
authors: Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Omihachiman, Japan.
authors: Kan
authors: K
authors: Zen
authors: Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan.
authors: Hiroyoshi
authors: H
authors: Yokoi
authors: Cardiovascular Center, Kansai Rosai Hospital, Hoyogo, Japan.
authors: Masaaki
authors: M
authors: Uematsu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D016638:Critical Illness; D016208:Databases, Factual; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D017239:Paclitaxel / Q000008:administration & dosage*; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012008:Recurrence; D019233:Retreatment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D002317:Cardiovascular Agents; D017239:Paclitaxel