Horie Kazunori, Takahara Mitsuyoshi, Takiuchi Shin, Okamoto Shin, Yoshioka Naoki, Kaneko Nobuhito, Ogata Kenji, Shintani Yoshiaki, Haraguchi Takuya, Ikeoka Kuniyasu, Kobayashi Tomoko, Suzuki Kenji, Fukai Kuniyoshi, Shima Yuki, Iiya Masahiro, Tada Norio, Iida Osamu
Department of Cardiovascular Medicine, Sendai Kousei Hospital, Miyagi, Japan.
Department of Laboratory Medicine, Osaka University Graduate School of Medicine, Japan.
J Endovasc Ther. 2025 Aug 20:15266028251363466. doi: 10.1177/15266028251363466.
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.
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.
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.
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.
指南推荐准分子激光消蚀术（ELA）用于股腘动脉支架内再狭窄（ISR）病变。然而，其在与裸金属支架（BMS）以外的支架相关的ISR中的疗效仍不明确。本研究旨在评估接受ELA血管内治疗（EVT）的股腘动脉ISR病变患者的1年临床结局。
这项回顾性多中心注册研究分析了2020年至2024年间因股腘动脉ISR病变接受EVT联合ELA治疗的外周动脉疾病患者。主要结局是EVT后1年的再狭窄。
总体而言，连续纳入了166例股腘动脉ISR病变患者。分别在88.6%和52.4%的病变中发现支架内闭塞和与BMS以外的支架相关的ISR。技术成功率为83.7%。1年无再狭窄的Kaplan-Meier估计值为67.6%（95%置信区间[CI]60.0-75.5）。主要辅助通畅率和次要通畅率分别为72.7%（95%CI 65.8-80.3）和81.5%（95%CI 76.6-88.0）。在多变量分析中，EVT完成血管造影时观察到的血流缓慢（调整后风险比，2.32；P = 0.024）和需要透析的慢性肾衰竭（1.72；P = 0.036）与再狭窄风险独立相关。这些因素的累积与较低的无再狭窄率相关；有1个或2个危险因素的亚组中，无再狭窄率的Kaplan-Meier估计值为46.6%，而无危险因素时为77.8%。Kaplan-Meier估计显示与BMS和药物洗脱支架相关的ISR在1年时的主要通畅率相当。
ELA在当前股腘动脉ISR病变中提供了可接受的技术成功率；然而，长期结果在临床上并不理想。
临床影响
这项回顾性多中心注册研究纳入了166例接受准分子激光消蚀术血管内治疗的股腘动脉支架内再狭窄/支架内闭塞病变患者。技术成功率为83.7%，可接受；然而，1年无再狭窄估计值在临床上并不理想，为67.6%。多变量分析显示顺行血流不完全和依赖透析的慢性肾衰竭与再狭窄风险独立相关。
