title: Clinical Outcomes of the Intraluminal Approach for Long Occlusive Femoropopliteal Lesions Assessed by Intravascular Ultrasound.
abstract: OBJECTIVE
  To investigate the relationship between intravascular ultrasound (IVUS) findings and restenosis after stent implantation for long occlusive femoropopliteal (FP) lesions using the intraluminal approach.
  
  
  METHODS
  This was a single-center retrospective study of 45 patients (49 lesions) with de novo long occlusive FP lesions treated with bare metal stents implanted using the intraluminal approach under IVUS guidance from April 2007 to December 2014. All patients were followed up at least 12 months. The preprocedural and postprocedural IVUS findings were compared for patients with and without restenosis, which was defined as a peak systolic velocity ratio of ＞2.4 on duplex ultrasonography or ＞50% diameter stenosis on angiography.
  
  
  RESULTS
  Within 12 months, 13 patients (14 lesions) developed restenosis, whereas 32 patients (35 lesions) did not (restenosis rate=29%). The male: female ratio and the prevalence of diabetes mellitus, hemodialysis, and critical limb ischemia were similar between the two groups. No significant differences were observed in lesion length, chronic total occlusion (CTO) length, and the percentage of involving popliteal lesion between the two groups. A whole intraplaque route was gained in 15 lesions (31%). Multivariate analysis revealed that the within-CTO intramedial route proportion and the distal lumen cross-sectional area (CSA) were independent predictors of restenosis. Receiver operating characteristic analysis showed that the best cutoff values of these parameters were 14.4% and 17.7 mm2, respectively.
  
  
  CONCLUSIONS
  In patients with long occlusive FP lesions undergoing stent placement using the intraluminal approach, a whole intraplaque route was gained in 31%. Restenosis is more likely if IVUS shows a within-CTO intramedial route proportion of ＞14.4% or distal lumen CSA of ＜17.7 mm2.
authors.affiliation: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Mori
authors.affiliation: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hirano
authors.affiliation: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamawaki
authors.affiliation: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital.
authors.forename: Motoharu
authors.initials: M
authors.lastname: Araki
authors.affiliation: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kobayashi
authors.affiliation: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Takimura
authors.affiliation: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital.
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Tsutsumi
authors.affiliation: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital.
authors.forename: Takuro
authors.initials: T
authors.lastname: Takama
authors.affiliation: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital.
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Honda
authors.affiliation: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tokuda
authors.affiliation: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital.
authors.forename: Kenji
authors.initials: K
authors.lastname: Makino
authors.affiliation: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital.
authors.forename: Shigemitsu
authors.initials: S
authors.lastname: Shirai
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D018592:Cross-Over Studies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: Chronic total occlusion; Femoropopliteal artery; Intraluminal approach; Intravascular ultrasound