Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis Medical Center, Sacramento, California.
Catheter Cardiovasc Interv. 2013 Dec 1;82(7):1168-74. doi: 10.1002/ccd.24983. Epub 2013 Jun 3.
The purpose of this study was to identify the relationship between angiographic patterns of restenosis and outcomes after endovascular treatment of femoro-popliteal in-stent restenosis (FP-ISR).
ISR is a frequent clinical problem after femoro-popliteal stenting.
This was a single center study of all endovascular interventions for FP-ISR from 2006 to 2012. Class I ISR was defined as focal lesions ≤50 mm; Class II ISR as lesions > 50 mm; and Class III ISR as stent chronic total occlusion. Recurrent ISR was defined as peak systolic velocity ratio > 2.4 by duplex ultrasound.
Among 75 cases of FP-ISR, 28 (37%) were Class I, 22 (29%) were Class II, and 25 (33%) were Class III. The mean lesion length was 26 mm for Class I, 135 mm for Class II, and 178 mm for Class III ISR. Patients with Class III ISR more frequently had ISR extending into both the superficial femoral and popliteal artery (48% vs. 18%, P = 0.005). Balloon angioplasty was used most frequently to treat Class I ISR, while adjunctive atherectomy and/or stenting was used for almost all cases of Class III ISR. During 2-year follow-up, rates of repeat restenosis were 39% for Class I, 67% for Class II, and 72% for Class III ISR (P = 0.04). Rates of stent occlusion were 8% for Class I, 11% for Class II, and 52% for Class III ISR (P = 0.009). Class III ISR was associated with significantly increased risk of recurrent ISR (HR 2.4, 95% CI 1.1-5.6) and recurrent occlusion (HR 5.8, 95% CI 1.8-19.0) compared to other types of ISR.
Angiographic patterns of FP-ISR are important determinants of subsequent outcomes. Repeat restenosis and occlusion remain common despite currently available technologies.
本研究旨在确定股腘段支架内再狭窄（FP-ISR）血管造影再狭窄模式与血管内治疗后结局之间的关系。
ISR 是股腘段支架置入后的常见临床问题。
这是一项 2006 年至 2012 年期间对所有 FP-ISR 血管内治疗的单中心研究。I 级 ISR 定义为局限性病变 ≤ 50mm；II 级 ISR 为病变 > 50mm；III 级 ISR 为支架慢性完全闭塞。通过双功能超声检查，再发 ISR 定义为收缩期峰值速度比 > 2.4。
在 75 例 FP-ISR 中，28 例（37%）为 I 级，22 例（29%）为 II 级，25 例（33%）为 III 级。I 级 ISR 的平均病变长度为 26mm，II 级 ISR 为 135mm，III 级 ISR 为 178mm。III 级 ISR 患者的 ISR 更频繁地延伸至股浅动脉和腘动脉（48%比 18%，P = 0.005）。球囊血管成形术最常用于治疗 I 级 ISR，而辅助旋切术和/或支架置入术几乎用于所有 III 级 ISR 病例。在 2 年随访期间，I 级 ISR 的再狭窄率为 39%，II 级 ISR 的再狭窄率为 67%，III 级 ISR 的再狭窄率为 72%（P = 0.04）。I 级 ISR 的支架闭塞率为 8%，II 级 ISR 的支架闭塞率为 11%，III 级 ISR 的支架闭塞率为 52%（P = 0.009）。与其他类型的 ISR 相比，III 级 ISR 与再发 ISR（HR 2.4，95%CI 1.1-5.6）和再发闭塞（HR 5.8，95%CI 1.8-19.0）的风险显著增加相关。
FP-ISR 的血管造影模式是随后结局的重要决定因素。尽管目前有可用的技术，但再发再狭窄和闭塞仍然很常见。
