The Endovascular Therapy Using Excimer Laser Atherectomy for Complex Femoropopliteal In-Stent Restenosis Lesions.

PURPOSE

The guidelines recommend excimer laser atherectomy (ELA) for in-stent restenosis (ISR) lesions in femoropopliteal arteries. However, its efficacy is still unknown in ISR related to scaffolds other than bare-metal stent (BMS). This study aimed to evaluate the 1-year clinical outcomes in patients with femoropopliteal ISR lesions treated with endovascular therapy (EVT) using ELA.

MATERIALS AND METHODS

This retrospective multicenter registry analyzed patients who presented with peripheral artery disease caused by femoropopliteal ISR lesions undergoing EVT with ELA between 2020 and 2024. The primary outcome was re-restenosis 1-year following EVT.

RESULTS

Overall, consecutive 166 patients with femoropopliteal ISR lesions were enrolled. The rates of in-stent occlusion and ISR related to scaffolds other than BMS were found in 88.6% and 52.4% of the lesions, respectively. Technical success was achieved in 83.7%. The 1-year Kaplan-Meier estimate of freedom from re-restenosis was 67.6% (95% confidence interval [CI] 60.0-75.5). The primary-assisted patency and secondary patency rate was 72.7% (95% CI 65.8-80.3) and 81.5% (95% CI 76.6-88.0), respectively. In the multivariate analysis, slow flow observed in the completion angiography of EVT (adjusted hazard ratio, 2.32;  = .024) and chronic renal failure requiring dialysis (1.72;  = .036) were independently associated with re-restenosis risk. The accumulation of these factors was associated with a lower rate of freedom from re-restenosis; Kaplan-Meier estimates of the rates were 46.6% in subgroups with 1 or 2 risk factors, whereas it was 77.8% in the absence of risk factors. The Kaplan-Meier estimate shows a comparable primary patency rate between ISR related to BMS and drug-eluting stent at 1 year.

CONCLUSION

ELA provided acceptable technical success in current femoropopliteal ISR lesions; however, the long-term result was clinically suboptimal.Clinical ImpactThis retrospective multicenter registry enrolled 166 patients with in-stent restenosis/in-stent occlusion lesions in femoropopliteal arteries treated with endovascular therapy using excimer laser atherectomy. The technical success rate was acceptable at 83.7%; however, 1-year estimate of freedom from restenosis was clinically suboptimal at 67.6%. The multivariate analysis showed incomplete antegrade blood flow and dialysis-dependent chronic renal failure were independently associated with re-restenosis risk.