Abstract
Purpose: To investigate if laser atherectomy with adjunctive balloon angioplasty can improve endovascular treatment outcomes for femoropopliteal in-stent restenosis (ISR). Methods: A dual center study included 135 symptomatic patients (mean age 71 years; 76 men) who underwent endovascular treatment of femoropopliteal ISR between 2006 and 2013. Of these, 54 (40%) were treated with laser atherectomy and the remaining 81 patients with balloon angioplasty alone. Angiographic images were reviewed for lesion morphology and characteristics, TransAtlantic InterSociety Consensus (TASC) II classification, and distal runoff. Class I ISR was defined as focal lesions ≤50 mm, class II ISR as lesions >50 mm, and class III ISR as stent total occlusion. Recurrent ISR was determined by a peak systolic velocity ratio >2.4 by duplex ultrasound. Results: Patients treated with laser atherectomy had longer mean ISR lesion length (222 vs 114 mm, p<0.001) and more class III ISR (69% vs 20%, p=0.001). There was no association between laser atherectomy and rates of recurrent restenosis or occlusion for patients with class I/II ISR, but there was a significantly lower rate of target lesion revascularization at 2 years among patients treated with laser atherectomy (14% vs 44%, p=0.05). In comparison, patients with class III ISR treated with laser atherectomy had lower rates of recurrent restenosis at 1 year (54% vs 91%, p=0.05) and 2 years (69% vs 100%, p=0.05). Patients with class III ISR treated with laser atherectomy also had lower rates of recurrent in-stent occlusion at 2-year follow-up (33% vs 71%, p=0.04). Conclusion: When used to treat complex ISR, including instent occlusions, laser atherectomy with adjunctive balloon angioplasty may be associated with improved patency.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 506-513 |
| Number of pages | 8 |
| Journal | Journal of Endovascular Therapy |
| Volume | 22 |
| Issue number | 4 |
| DOIs | |
| State | Published - Aug 1 2015 |
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Keywords
- Balloon angioplasty
- In-stent restenosis
- Laser atherectomy
- Patency
- Peripheral artery disease
- Reocclusion
- Stent
- Superficial femoral artery
- Target lesion revascularization
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Radiology Nuclear Medicine and imaging
Cite this
Laser atherectomy for treatment of femoropopliteal in-stent restenosis. / Armstrong, Ehrin J.; Thiruvoipati, Thejasvi; Tanganyika, Kundai; Singh, Gagan; Laird, John R.
In: Journal of Endovascular Therapy, Vol. 22, No. 4, 01.08.2015, p. 506-513.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Laser atherectomy for treatment of femoropopliteal in-stent restenosis
AU - Armstrong, Ehrin J.
AU - Thiruvoipati, Thejasvi
AU - Tanganyika, Kundai
AU - Singh, Gagan
AU - Laird, John R.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Purpose: To investigate if laser atherectomy with adjunctive balloon angioplasty can improve endovascular treatment outcomes for femoropopliteal in-stent restenosis (ISR). Methods: A dual center study included 135 symptomatic patients (mean age 71 years; 76 men) who underwent endovascular treatment of femoropopliteal ISR between 2006 and 2013. Of these, 54 (40%) were treated with laser atherectomy and the remaining 81 patients with balloon angioplasty alone. Angiographic images were reviewed for lesion morphology and characteristics, TransAtlantic InterSociety Consensus (TASC) II classification, and distal runoff. Class I ISR was defined as focal lesions ≤50 mm, class II ISR as lesions >50 mm, and class III ISR as stent total occlusion. Recurrent ISR was determined by a peak systolic velocity ratio >2.4 by duplex ultrasound. Results: Patients treated with laser atherectomy had longer mean ISR lesion length (222 vs 114 mm, p<0.001) and more class III ISR (69% vs 20%, p=0.001). There was no association between laser atherectomy and rates of recurrent restenosis or occlusion for patients with class I/II ISR, but there was a significantly lower rate of target lesion revascularization at 2 years among patients treated with laser atherectomy (14% vs 44%, p=0.05). In comparison, patients with class III ISR treated with laser atherectomy had lower rates of recurrent restenosis at 1 year (54% vs 91%, p=0.05) and 2 years (69% vs 100%, p=0.05). Patients with class III ISR treated with laser atherectomy also had lower rates of recurrent in-stent occlusion at 2-year follow-up (33% vs 71%, p=0.04). Conclusion: When used to treat complex ISR, including instent occlusions, laser atherectomy with adjunctive balloon angioplasty may be associated with improved patency.
AB - Purpose: To investigate if laser atherectomy with adjunctive balloon angioplasty can improve endovascular treatment outcomes for femoropopliteal in-stent restenosis (ISR). Methods: A dual center study included 135 symptomatic patients (mean age 71 years; 76 men) who underwent endovascular treatment of femoropopliteal ISR between 2006 and 2013. Of these, 54 (40%) were treated with laser atherectomy and the remaining 81 patients with balloon angioplasty alone. Angiographic images were reviewed for lesion morphology and characteristics, TransAtlantic InterSociety Consensus (TASC) II classification, and distal runoff. Class I ISR was defined as focal lesions ≤50 mm, class II ISR as lesions >50 mm, and class III ISR as stent total occlusion. Recurrent ISR was determined by a peak systolic velocity ratio >2.4 by duplex ultrasound. Results: Patients treated with laser atherectomy had longer mean ISR lesion length (222 vs 114 mm, p<0.001) and more class III ISR (69% vs 20%, p=0.001). There was no association between laser atherectomy and rates of recurrent restenosis or occlusion for patients with class I/II ISR, but there was a significantly lower rate of target lesion revascularization at 2 years among patients treated with laser atherectomy (14% vs 44%, p=0.05). In comparison, patients with class III ISR treated with laser atherectomy had lower rates of recurrent restenosis at 1 year (54% vs 91%, p=0.05) and 2 years (69% vs 100%, p=0.05). Patients with class III ISR treated with laser atherectomy also had lower rates of recurrent in-stent occlusion at 2-year follow-up (33% vs 71%, p=0.04). Conclusion: When used to treat complex ISR, including instent occlusions, laser atherectomy with adjunctive balloon angioplasty may be associated with improved patency.
KW - Balloon angioplasty
KW - In-stent restenosis
KW - Laser atherectomy
KW - Patency
KW - Peripheral artery disease
KW - Reocclusion
KW - Stent
KW - Superficial femoral artery
KW - Target lesion revascularization
UR - http://www.scopus.com/inward/record.url?scp=84940181003&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84940181003&partnerID=8YFLogxK
U2 - 10.1177/1526602815592133
DO - 10.1177/1526602815592133
M3 - Article
C2 - 26130385
AN - SCOPUS:84940181003
VL - 22
SP - 506
EP - 513
JO - Journal of Endovascular Therapy
JF - Journal of Endovascular Therapy
SN - 1526-6028
IS - 4
ER -