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Potential mechanisms of in-stent occlusion in the femoropopliteal artery: an angioscopic assessment

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Abstract

Although stent implantation has become widespread for the treatment of patients with peripheral artery disease with femoropopliteal (FP) lesions, in-stent restenosis, especially in-stent occlusion (ISO), remains as a major concern for refractory recurrence. Furthermore, the mechanisms of ISO in FP lesions have not been well elucidated. We performed angioscopy for 6 lesions (bare-metal stent: 3, drug-eluting stent: 3) from 5 patients (mean age 74 ± 10 years, male 40 %) with ISO in the FP artery immediately after wire-passing or thrombus aspiration. The presence of thrombus as well as the presence and location of organic stenosis were evaluated. Median duration from stent implantation to angioscopic evaluation was 1099.5 (514.5–2272.5) days, while the duration from recurrence of symptoms to angioscopic evaluation was 45 (5.75–60) days. Mixed thrombi were observed in all stents. Organic stenosis was detected at the proximal edge of the stents in 5 lesions. Organic stenosis was observed at the overlapping segment of the stent in one lesion. The distal edge of the stents could be evaluated in 3 lesions, and all of them showed organic stenosis at the site. Mixed thrombi and organic stenosis were observed in all stents. Partial development of organic stenosis in a stent followed by thrombus formation may be the potential mechanism of the development of ISO in the FP artery though the sample size of this study was small and it had no serial angioscopic data so that we should consider it as preliminary one at best.

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Authors and Affiliations

  1. Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, 660-8511, Japan

    Takayuki Ishihara, Osamu Iida, Shin Okamoto, Masashi Fujita, Masaharu Masuda, Kiyonori Nanto, Tatsuya Shiraki, Takashi Kanda, Takuya Tsujimura, Shota Okuno, Koji Yanaka & Masaaki Uematsu

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  1. Takayuki Ishihara
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  2. Osamu Iida
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  3. Shin Okamoto
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  4. Masashi Fujita
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  5. Masaharu Masuda
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  6. Kiyonori Nanto
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  7. Tatsuya Shiraki
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  8. Takashi Kanda
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  9. Takuya Tsujimura
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  10. Shota Okuno
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  11. Koji Yanaka
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  12. Masaaki Uematsu
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Corresponding author

Correspondence to Takayuki Ishihara.

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All authors have no conflict of interests.

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This study involved human participants. This study was approved by the ethics committee of Kansai Rosai Hospital, and all patients provided written informed consent.

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Ishihara, T., Iida, O., Okamoto, S. et al. Potential mechanisms of in-stent occlusion in the femoropopliteal artery: an angioscopic assessment. Cardiovasc Interv and Ther 32, 313–317 (2017). https://doi.org/10.1007/s12928-016-0411-3

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  • DOI: https://doi.org/10.1007/s12928-016-0411-3

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