Abe Hiroshi, Ozaki Dai, Isogai Hiroyuki, Tokano Takashi, Minamino Tohru
Cardiology, Juntendo University Urayasu Hospital, Urayasu, JPN.
Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Hongouku, JPN.
Cureus. 2024 Oct 30;16(10):e72696. doi: 10.7759/cureus.72696. eCollection 2024 Oct.
Endovascular therapy (EVT) utilizing self-expanding stent grafts has shown promising clinical outcomes for femoropopliteal lesions. However, restenosis and thrombotic occlusion remain significant concerns with unclear underlying mechanisms. This is the case of a 53-year-old male with diabetic nephropathy requiring hemodialysis. He presented with left lower limb intermittent claudication and underwent EVT, resulting in subsequent restenosis 12 months post-implantation and recurrence of symptoms. Intravascular imaging revealed neointimal proliferation and stent-edge restenosis, with segments of neointima not in contact with the stent. A second EVT procedure was performed successfully with the endograft extension. Our case highlights the challenges in diagnosing and managing stent graft restenosis. Intravascular imaging modalities such as optical coherence tomography (OCT) were crucial in identifying the etiology and guiding treatment decisions. The presence of neointima not in contact with the stent suggests a potential mechanism for thrombus formation and underscores the importance of tailored treatment strategies. This case underscores the utility of OCT in evaluating stent graft restenosis and guiding therapeutic interventions. Further research is warranted to elucidate optimal treatment strategies for this challenging complication.
利用自膨式覆膜支架的血管内治疗（EVT）已显示出在治疗股腘动脉病变方面有良好的临床效果。然而，再狭窄和血栓闭塞仍然是重大问题，其潜在机制尚不清楚。本文报告了一名53岁患有糖尿病肾病且需要血液透析的男性患者。他因左下肢间歇性跛行就诊并接受了EVT治疗，植入后12个月出现再狭窄且症状复发。血管内成像显示新生内膜增生和支架边缘再狭窄，部分新生内膜未与支架接触。通过延长覆膜支架成功进行了第二次EVT手术。我们的病例突出了诊断和处理覆膜支架再狭窄的挑战。诸如光学相干断层扫描（OCT）等血管内成像方式对于确定病因和指导治疗决策至关重要。未与支架接触的新生内膜的存在提示了血栓形成的潜在机制，并强调了定制治疗策略的重要性。该病例强调了OCT在评估覆膜支架再狭窄和指导治疗干预方面的实用性。有必要进行进一步研究以阐明针对这一具有挑战性的并发症的最佳治疗策略。
