Lichtenberg Michael K, Carr Jeffrey G, Golzar Jaafer A
Vascular Centre Arnsberg Clinic, Arnsberg, Germany -
Cardiovascular Associates of East Texas, Tyler, TX, USA.
J Cardiovasc Surg (Torino). 2017 Aug;58(4):518-527. doi: 10.23736/S0021-9509.17.09946-3. Epub 2017 Apr 4.
Approximately 27 million people in Europe and North America currently have peripheral arterial disease (PAD). The endovascular treatment of stenosis or blocked peripheral arteries in PAD include percutaneous transluminal angioplasty with or without a drug coated balloon (DCB), atherectomy (rotational, directional, orbital or laser), and stenting. The development of next generation peripheral stents and drug-coated stents have led to the improved treatment of complex superficial femoral artery (SFA) lesions, and consequently increased their usage. Additionally, the technologies developed for PAD intervention have further improved the overall adoption of endovascular procedures leading to increased utilization of stents to address procedural dissections (bailout stenting), as support scaffolding for complex lesions, and to prevent preventing elastic recoil post balloon angioplasty. For example, bail-out stenting after DCB angioplasty has been reported to be as high as 40% in long lesions and as high as 46% in chronic total occlusions lesions. In total, approximately 200,000 stents are placed annually in the femoral and popliteal arteries in PAD patients in the USA, with 30% to 40% of these stents expected to develop in-stent restenosis within 2-3 years of implantation. Accordingly, the treatment of in-stent restenosis (ISR) remains a substantial healthcare burden. Few technologies reported on improved ISR patency rates as compared to PTA treatment alone, including drug-eluting stents and balloons, laser atherectomy or covered stents. However, the reported longer-term patency for ISR remains suboptimal creating a cyclical treatment pattern that burdens patients and providers. In this review, we present the rational and clinical evidence for utilizing OCT-guided therapies for the treatment of ISR for PAD.
目前，欧洲和北美约有2700万人患有外周动脉疾病（PAD）。PAD中狭窄或阻塞的外周动脉的血管内治疗包括有或没有药物涂层球囊（DCB）的经皮腔内血管成形术、旋切术（旋转、定向、轨道或激光）和支架置入术。下一代外周支架和药物涂层支架的发展改善了对复杂股浅动脉（SFA）病变的治疗，从而增加了它们的使用。此外，为PAD介入开发的技术进一步提高了血管内手术的整体采用率，导致支架在处理手术夹层（补救性支架置入）、作为复杂病变的支撑支架以及防止球囊血管成形术后弹性回缩方面的使用增加。例如，据报道，DCB血管成形术后在长病变中的补救性支架置入率高达40%，在慢性完全闭塞病变中高达46%。在美国，每年PAD患者的股动脉和腘动脉中总共放置约20万个支架，其中30%至40%的支架预计在植入后2至3年内发生支架内再狭窄。因此，支架内再狭窄（ISR）的治疗仍然是一项巨大的医疗负担。与单独的PTA治疗相比，很少有技术报道能提高ISR的通畅率，包括药物洗脱支架和球囊、激光旋切术或覆膜支架。然而，报道的ISR长期通畅率仍然不理想，形成了一种给患者和医疗服务提供者带来负担的循环治疗模式。在本综述中，我们介绍了利用光学相干断层扫描（OCT）引导疗法治疗PAD的ISR的理论依据和临床证据。
