Drug-coated stent implantation vs. bypass surgery for in-stent occlusion after femoropopliteal stenting

• Published in: Heart and vessels 2021-05, Vol.36 (5), p.646-653
• Main Authors: Tomoi, Yusuke, Soga, Yoshimitsu, Okazaki, Jin, Iida, Osamu, Shiraki, Tatsuya, Hiramori, Seiichi, Ando, Kenji
• Format: Article
• Language: English
• Subjects: Angiography; Biomedical Engineering and Bioengineering; Cardiac Surgery; Cardiology; Complications; Grafting; Heart surgery; Implantation; Implants; Intermetallic compounds; Lesions; Males; Medicine; Medicine & Public Health; Nickel titanides; Occlusion; Original Article; Patients; Restenosis; Stenosis; Stents; Surgery; Surgical implants; Vascular Surgery; Velocity
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-020-01740-8

The optimal revascularization for in-stent occlusion (ISO) lesions after femoropopliteal (FP) bare-nitinol stenting has not been established. We, therefore, investigated the comparison between drug-coated stent (DCS) implantation and bypass surgery (BSX) for ISO lesions after FP bare-nitinol stenting. This study was a dual-center, observational study from January 2004 to December 2015. A total of 172 ISO lesions were observed, and after excluding 120 ISO lesions, 52 ISO lesions (50 patients; mean age, 71.0 ± 9.2 years; male, 59.6%) after FP bare-nitinol stenting were enrolled. The included patients with clinical symptoms underwent either DCS implantation ( n  = 28) or BSX ( n  = 22). The primary endpoint was recurrent in-stent restenosis (ReISR); secondary endpoints were recurrent target lesion revascularization (ReTLR), recurrent occlusion (reocclusion) and major adverse limb events (MALE), and perioperative complications (POCs), respectively. ReISR or reocclusion was defined as ISR or occlusion after TLR. Stent restenosis was defined as a peak systolic velocity ratio (PSVR) > 2.4 on a duplex scan or ≥ 50% stenosis on angiography. Graft restenosis was defined as a PSV > 300 cm/s and velocity ratio 3.5 or uniformly low PSV