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Addition of laser atherectomy improves patency in complex in-stent restenosis
Patients with complex femoropopliteal in-stent restonsis who received laser atherectomy in addition to balloon angioplasty had improved patency compared with patients who received balloon angioplasty alone.
The dual-center study included 135 symptomatic patients (mean age, 71 years; 56.3% men) with femoropopliteal in-stent restenosis (ISR) who underwent endovascular treatment from 2006 to 2013. Forty percent of patients received laser atherectomy with standard balloon angioplasty, whereas the remainder received standard balloon angioplasty alone.
Researchers analyzed angiographic images to determine lesion morphology and characteristics, TransAtlantic InterSociety Consensus (TASC) II classification and distal runoff. They defined class I ISR as focal lesions ≤ 50 mm; class II ISR as lesions > 50 mm; class III ISR as stent total occlusion; and recurrent ISR as a peak systolic velocity ratio > 2.4, according to duplex ultrasound.
Overall, patients who received laser atherectomy had longer ISR lesion length (222 mm vs. 114 mm; P < .001) and a higher rate of class III ISR (69% vs. 20%; P = .001).
Among patients with class I or II ISR, the researchers found no difference between groups in the rates of recurrent restenosis or occlusion; however, the 2-year rate of target lesion revascularization was lower in patients who received laser atherectomy (14% vs. 44%; P = .05).
Additional data revealed that patients with class III ISR who received laser atherectomy had reduced rates of recurrent restenosis at 1 year (54% vs. 91%; P = .05) and 2 years (69% vs. 100%; P = .05), and a lower rate of recurrent in-stent occlusion at 2 years (33% vs. 71%; P = .04).
The researchers noted that the efficacy of laser atherectomy in this patient population is due to the debulking of neointima and thrombus, and the suppression of platelet aggregation. They added that the mechanisms of this therapy “may improve the outcomes after endovascular treatment of [femoropopliteal] ISR when compared with standard balloon angioplasty. This more extensive plaque modification could also explain the lower rates of TLR that we observed in patients with class I/II [femoropopliteal] ISR who were treated with laser atherectomy.” – by Brian Ellis
Disclosure: One researcher reports consulting for Abbott, Bard, Boston Scientific, Covidien and Medtronic, and receiving research support from W.L. Gore. Another researcher reports consulting for Abbott Vascular, Medtronic, Merck and Spectranetics. The other researchers report no relevant financial disclosures.