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In-stent restenosis (ISR) in the superficial femoral artery (SFA) remains to be an Achilles heel of endovascular treatment of obstructive PAD. Stent fracture (SF) was identified as one of possible causes of ISR, but data on the role of SF in development of ISR remains controversial.
We studied 97 consecutive patients (105 limbs) with angiographically confirmed obstructive nitinol self-expandable stent ISR in the SFA. Mean age of the group was 73.31±8.28 years, 45% females, 31% smokers, 65% Diabetes. We excluded patients with Viabahn stents. Stents were evaluated by fluoroscopy/ CINE using at least 2 orthgonal views for SF presence. We analyzed SF rates, severity and angiographic relationship to restenosis, number of stents, stented length, stent diameter and type, run off score, smoking, age, sex, and presence of co-morbidities were analyzed as well.
Mean time from stent implantation to presentation with ISR was 15.5±15.3 months. Out of 105 limbs with ISR, SF was present in 31 (30%) limbs and among those only 3 (10%) limbs had SF angiographically associated with ISR. SF occurred more frequently in males (p<0.036). Mean stented length was numerically but not statistically longer in patients with SF than in those without, 218.1±101 versus 194.8±103.2 (p=0.297), respectively. There were no differences in other procedural and demographic characteristics between groups with and without SF.
Stent fractures in SFA play a modest role in the development of ISR. In our study, the association was seen in only 10% limbs (3 out of 31 limbs) with SF, which corresponds to 2.9% of total 105 limbs with ISR. Majority of the patients with ISR did not have SF. Stent fracture occurred more frequently in males.