Drug-Eluting Stent vs Percutaneous Transluminal Angioplasty for Treatment of Femoropopliteal In-Stent Restenosis

Abstract

DES implantation may be more effective than PTA in the management of femoropopliteal ISR with occlusion, but equally effective to PTA in nonocclusive ISR lesions. These results require confirmation in prospective randomized studies.

Rotational Atherectomy Plus Drug-Coated Balloon Angioplasty for the Treatment of Total In-Stent Occlusions in Iliac and Infrainguinal Arteries

“…9 However, a recently published comparative analysis of treatment outcomes in 119 patients implanted with Zilver PTX stents and a historical cohort of 116 individuals subjected to balloon angioplasty demonstrated less satisfactory primary patency rates at 1 year (40.5% for angioplasty vs 45.7% for Zilver PTX stents). 10 Moreover, multivariate analysis identified DES implantation as an independent predictor of repeated restenosis in patients with total occlusion at baseline. 10 Several authors analyzed the results of DCB angioplasty in SFA ISR (Table 4).…”

“…10 Moreover, multivariate analysis identified DES implantation as an independent predictor of repeated restenosis in patients with total occlusion at baseline. 10 Several authors analyzed the results of DCB angioplasty in SFA ISR (Table 4). In 1 study, the primary patency rate at 1 year after angioplasty with the IN.PACT drug-coated balloon was 92.1%.…”

Treatment of Femoropopliteal Artery In-stent Restenosis

“…DES implantation was associated with significantly lower incidences of recurrent restenosis (44.1% vs. 90.3%; p<0.001). 23) Many operators advocate a strategy of avoiding repeat stent implantation among patients with FP artery-ISR. When flow-limiting dissection occurs in a subset of patients undergoing conventional BA, then repeat stent implantation may be necessary to maintain an adequate luminal flow.…”

Laser Atherectomy Combined With Drug-Coated Balloon Angioplasty Is Associated With Improved 1-Year Outcomes for Treatment of Femoropopliteal In-Stent Restenosis

“…4 Available treatment strategies for FP-ISR include conventional balloon angioplasty (BA), cutting balloons, laser atherectomy, self-expanding covered stents, drugeluting stents, and drug-coated balloons (DCBs). [5][6][7][8][9][10][11][12][13] Given that avoiding an extra stent layer is appealing, recent research attempts have been concentrated on treatment strategies that can avoid repeat stent implantation. Moreover, while Tosaka I lesions (FP-ISR <5 cm) can be effectively treated with relatively simple strategies, lesions of increasing complexity, including Tosaka II (FP-ISR >5 cm) and Tosaka III (in-stent occlusion), result in poor outcomes with conventional approaches.…”

“…4 Available treatment strategies for FP-ISR include conventional balloon angioplasty (BA), cutting balloons, laser atherectomy, self-expanding covered stents, drug-eluting stents, and drug-coated balloons (DCBs). 5–13…”