Garcia Lawrence A, Rocha-Singh Krishna J, Krishnan Prakash, Zeller Thomas, Tepe Gunnar, Fleming Mark, Granada Juan F, Turco Mark A, Tieché Christopher, Jaff Michael R
St. Elizabeth's Medical Center, Boston, Massachusetts.
St. John's Hospital, Prairie Education and Research Cooperative, Springfield, Illinois.
Catheter Cardiovasc Interv. 2017 Oct 1;90(4):639-646. doi: 10.1002/ccd.27198. Epub 2017 Aug 10.
To propose a classification system for characterizing angiographic femoropopliteal artery restenosis patterns associated with common endovascular modalities.
Peripheral artery disease is a worldwide issue affecting millions of people. Despite a myriad of endovascular technologies available to treat peripheral artery disease of the femoropopliteal arteries, restenosis remains a common failure mode. Characterizing common patterns of restenosis is important to discern the potential impact of baseline patient, lesion, and procedural characteristics, as well as treatment modalities on either the primary success or the failure patterns associated with restenosis.
Studies included in the analysis were from previous core laboratory-adjudicated femoropopliteal artery disease trials and registries reflecting a wide array of treatment modalities.
From the subjects enrolled and analyzed, there were 403 total angiograms for analysis and adjudication. Target lesion revascularization images of the 32 validation cases were evaluated for index treated length, diameter stenosis, and lesion morphology characteristics. The following lesion types are proposed: Type 1 "Focal" pattern, which may be "Edge Proximal" or "Edge Distal" depending on location; a Type 2 "Multifocal" pattern which may also exhibit edge restenosis, but may also be "Edge Bilateral"; a Type 3 "Moderate" pattern and a Type 4 "Diffuse" pattern; and finally, a Type 5 "Occlusion".
A classification system that enables healthcare professionals to anticipate and describe failures following the index procedure, thereby impacting the choice of options for retreatment, may facilitate consistency and standardization within the heterogeneous field of endovascular device treatments for the femoropopliteal artery.
提出一种用于描述与常见血管内治疗方式相关的股腘动脉血管造影再狭窄模式的分类系统。
外周动脉疾病是一个影响数百万人的全球性问题。尽管有众多血管内技术可用于治疗股腘动脉外周动脉疾病，但再狭窄仍然是常见的失败模式。表征常见的再狭窄模式对于识别基线患者、病变和手术特征以及治疗方式对初次成功或与再狭窄相关的失败模式的潜在影响非常重要。
纳入分析的研究来自先前核心实验室判定的股腘动脉疾病试验和登记处，反映了广泛的治疗方式。
在纳入并分析的受试者中，共有403张血管造影照片用于分析和判定。对32例验证病例的靶病变血运重建图像进行索引治疗长度、直径狭窄和病变形态特征评估。提出了以下病变类型：1型“局灶性”模式，根据位置可能是“近端边缘”或“远端边缘”；2型“多灶性”模式，也可能表现为边缘再狭窄，但也可能是“双侧边缘”；3型“中度”模式和4型“弥漫性”模式；最后是5型“闭塞”。
一种能够使医疗保健专业人员预测和描述索引手术后失败情况从而影响再治疗选择的分类系统，可能有助于在股腘动脉血管内装置治疗的异质领域内实现一致性和标准化。
