Author + information
- Nicolas W. Shammas,
- Gail A. Shammas,
- Alexander Hafez,
- Ryan Kelley,
- Emily Reynolds and
- Andrew N. Shammas
Treatment of in-stent restenosis of the femoropopliteal artery is challenging with a high rate of restenosis. Excimer laser atherectomy (ELA) has a theoretical advantage of ablating restenotic tissue and reducing or delaying the need for repeat revascularization. We present a retrospective analysis from our center on the outcomes of ELA in the treatment of in-stent restenosis of the femoropopliteal arteries.
Demographic, clinical, angiographic and procedural data was collected on all patients that underwent ELA for in-stent restenosis from January 2005 until June 2010. Major adverse events and one-year target lesion revascularization (TLR) and target vessel revascularization (TVR) were obtained by reviewing of medical records. Descriptive analysis was performed on all variables. Kaplan-Meier survival curves for TLR were plotted.
40 consecutive patients (mean age 67.7 ± 9.0 years, 57.5% males) were included and followed for 1 year. The following variables were noted: mean ankle brachial index (ABI) of treated leg 0.6 ± 0.2; diabetes 47.5%; history of smoking 82.5%; number of vessel runoffs of treated limb 1.7 ± 1.0; hypertension 85.0%; lesion length 210.4 ± 104.0 mm; lesion severity 93.9 ± 8.9%; vessel diameter 5.6 ± 0.7 mm. 95% of patients received bivalirudin during the procedure and all were on aspirin and clopidogrel. Adjunctive balloon angioplasty was performed in 100% at a mean pressure of 12.4 ± 2.9 atm. Acute procedural success (< 30% angiographic residual narrowing) occurred in 92.5% of patients. Embolic filter protection (EFP) was used in 57.5% of patients. Bailout stenting was 50.0%. Macrodebris was noted in 65.2% of filters. The following adverse events were reported: distal embolization (DE) requiring treatment 2.5% (patient with no EFP); planned minor amputation 2.5%, planned major amputation 2.5%, total death 7.5% (all cardiac related). One perforation occurred treated successfully with stenting. At one year, TLR and TVR occurred in 48.7% and 48.7% respectively.
ELA has an overall favorable acute result in treating in-stent restenosis of the femoropopliteal artery. At one year TLR and TVR remain clinically high. DE also occurs significantly with ELA and EFP appears to be effective in capturing the debris.
- 2013 American College of Cardiology Foundation