Factors Influencing in-Stent Occlusion after Femoropopliteal Artery Stent Placement with Intravascular Ultrasound Evaluation

Kurata, Naoya; Iida, Osamu; Asai, Mitsutoshi; Masuda, Masaharu; Okamoto, Shin; Ishihara, Takayuki; Nanto, Kiyonori; Mano, Toshiaki

doi:10.1016/j.jvir.2019.08.014

Cited by 20 publications

(15 citation statements)

References 19 publications

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“…Previous studies have demonstrated that small distal reference vessel diameters and/or distal plaque burden are significantly associated with restenosis and reocclusion after stent implantation. 16,22 Small vessel lesions remain still challenging even in the current era of paclitaxel-based devices and may entail the potential risks of ISR. Hence, DCB angioplasty might be an acceptable option for the treatment of small vessel lesions, because of avoiding stent-related complications even if restenosis occurs.…”

Section: Discussionmentioning

confidence: 99%

“…14 Then, the lumen CSA and external elastic membrane (EEM) CSA were measured at the proximal and distal reference segments. 14,16 After DCB dilatation, the image slice with the minimum lumen area (MLA) was selected for analysis. All the lesions within the femoropopliteal segment were characterized according to the Trans-Atlantic Inter-Society Consensus II classification.…”

Section: Methodsmentioning

confidence: 99%

“…Intravascular ultrasound (IVUS) can provide high-resolution, cross-sectional images of the vessel walls; therefore, IVUS-guided intervention is a common strategy in percutaneous revascularization of coronary and peripheral arteries. 14–16 IVUS can reveal information about plaque morphology, vessel diameter, calcification angle, and intra-plaque or subintimal passage of the wire. Although severe calcification has been shown in a recent study to be associated with poor primary patency after DCB treatment of femoropopliteal lesions, 10 there is a dearth of research on the relationship between other IVUS parameters and the patency rate.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Baseline and Postprocedural Intravascular Ultrasound Findings on 1-Year Primary Patency After Drug-Coated Balloon Treatment of Femoropopliteal Lesions

et al. 2021

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Purpose: Drug-coated balloons (DCBs) are commonly used for endovascular treatment of femoropopliteal lesions. Here, we employed intravascular ultrasound (IVUS) to investigate the predictors of restenosis after DCB treatment. Methods: This retrospective and single-center study was performed to examine 1-year primary patency after DCB treatment and to identify the risk factors for restenosis by analyzing clinical characteristics, angiographic findings, and IVUS measurements. We included 111 consecutive patients undergoing DCB treatment for de novo femoropopliteal lesions at our hospital from July 2018 to March 2020. Results: The primary patency rate was found to be 80.0% at 1 year. The Cox proportional hazard multivariate analysis revealed that restenosis was independently associated with chronic total occlusion (CTO; p < 0.001), circumferential calcification (p = 0.023), and smaller postprocedural minimum lumen area (MLA; p = 0.036). Furthermore, receiver operating characteristic curve analysis showed that the cutoff value of postprocedural MLA to prevent restenosis was 12.7 mm2, with an area under the curve of 0.774 (p< 0.001). The multivariate analysis indicated that patients with a postprocedural MLA below 12.7 mm2 (n = 44) had a significantly smaller distal reference vessel size (p < 0.001) compared to those with a postprocedural MLA over 12.7 mm2 (n = 67). Conclusions: Restenosis after DCB treatment was shown to correlate with CTO, circumferential calcification, and postprocedural MLA as evaluated by IVUS. Moreover, smaller vessel sizes might represent a particular challenge to the DCB strategy due to the difficulty of restoring a sufficient postprocedural lumen area by balloon dilatation.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Baseline and Postprocedural Intravascular Ultrasound Findings on 1-Year Primary Patency After Drug-Coated Balloon Treatment of Femoropopliteal Lesions

et al. 2021

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“…Iida et al reported that IVUS use in femoropopliteal stenting appears to be associated not only with the procedure's success but also with a higher primary patency rate 56 . Previous reports were based on the IVUS evaluation methodology, such as vessel size, lumen area, wire route, calcification, lesion morphology, and vessel dissection after balloon angioplasty (Iida et al 2021;Kozuki et al 2021;Kurata et al 2020;Miki et al 2020a;Miki et al 2020b). Some parameters that influenced patency outcomes were shown, including calcification, vessel dissection, and post stent area and position (Iida et al 2015;Mori et al 2017;Norgren et al 2007).…”

Section: Discussionmentioning

confidence: 99%

Intravascular ultrasound-based decision tree model for the optimal endovascular treatment strategy selection of femoropopliteal artery disease—results from the ONION Study-

Yazu

Fujihara²,

Takahara³

et al. 2022

CVIR Endovasc

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Background The role of catheter-based imaging in peripheral interventions for lower extremity artery disease (LEAD) has increased with percutaneous interventions. To clarify the relation between intravascular ultrasound (IVUS) information and procedure selection strategy for endovascular treatment therapy (EVT) of the femoropopliteal artery in the real-world clinical settings wherein new endovascular technologies (NETs), including drug-coated balloon (DCB), drug-eluting stent (DES), and covered stent-graft (CS). Our retrospective multicenter analysis examined symptomatic 970 patients treated by EVT for de novo femoropopliteal lesions with IVUS guidance. The decision tree analysis was performed retrospectively to determine the association of IVUS and angiography parameters with the strategy selection of endovascular procedures. We divided the study population according to the developed tree, and identified the most popular strategy selection in each subgroup. We finally examined whether the restenosis risk would be different among respective subgroups of the tree. Results During the study periods, plain old balloon angioplasty, DCB, and bare nitinol stent were most frequently selected (25.3%, 23.9%, and 23.8%, respectively). The drug-eluting stent (DES), covered stent (CS), and spot stent strategies were used in 7.3%, 11.5%, and 8.1%. NETs had the lowest restenosis risk in the overall population. The decision tree had a depth of six branches and divided the patients into 11 subgroups by IVUS and angiography parameters. The restenosis rate was similarly low among these 11 subgroups when the most popular NET in each subgroup was selected (P = 0.94). Conclusions The use of IVUS data along with angiography data would standardize the selection of endovascular procedures and can improve patency outcomes if NETs are used properly.

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“…The most normal-looking sections within 10 mm of the proximal and distal margins of the lesion were selected as the proximal and distal reference segments. The plaque burden was defined as the area occupied by plaque between these leading edges and was calculated as the proportion of the entire EEM occupied by atherosclerotic plaque throughout the segment of interest (10). Plaque burden was used for analysis, with the more severe values at the proximal and distal sites as representative values.…”

Section: Analysis Of Intravascular Usmentioning

confidence: 99%

Predictive Factors for Restenosis Following Stent-Supported Endovascular Therapy with Intravascular Ultrasound Evaluation for Femoropopliteal Chronic Total Occlusion

Kurata

Iida

Takahara

et al. 2021

Journal of Vascular and Interventional Radiology

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Factors Influencing in-Stent Occlusion after Femoropopliteal Artery Stent Placement with Intravascular Ultrasound Evaluation

Cited by 20 publications

References 19 publications

Impact of Baseline and Postprocedural Intravascular Ultrasound Findings on 1-Year Primary Patency After Drug-Coated Balloon Treatment of Femoropopliteal Lesions

Impact of Baseline and Postprocedural Intravascular Ultrasound Findings on 1-Year Primary Patency After Drug-Coated Balloon Treatment of Femoropopliteal Lesions

Intravascular ultrasound-based decision tree model for the optimal endovascular treatment strategy selection of femoropopliteal artery disease—results from the ONION Study-

Predictive Factors for Restenosis Following Stent-Supported Endovascular Therapy with Intravascular Ultrasound Evaluation for Femoropopliteal Chronic Total Occlusion

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