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Femoropopliteal stent thrombosis linked to treatment of CTO, in-stent restenosis lesions
Patients are more likely to develop femoropopliteal stent thrombosis when undergoing treatment for chronic total occlusions or in-stent restenosis lesions, according to an analysis of data from the XLPAD registry.
Using a cohort of 604 patients who underwent 724 stent procedures between May 2005 and January 2015, Subhash Banerjee, MD, from the VA North Texas Healthcare System in Dallas, and colleagues compared cases in which stenting did or did not result in subsequent femoropopliteal stent thrombosis, with a median follow-up of 6 months.
Subhash Banerjee
Stent thrombosis occurred in 4.3% of patients, including 21 definite cases, one probable case and four possible cases. Thrombosis was more likely to develop among patients who were initially treated for CTOs (88.5% of those with thrombosis vs. 64% of those without; P = .01). Patients with stent thrombosis also had greater lesion lengths (171 mm vs. 126.8 mm; P = .011) and stent lengths (246.2 mm vs. 194.7 mm; P = .035). Thrombosis incidence did not differ according to whether drug-coated or bare-metal stents were used (4.4% vs. 3.4%; P = .55), but the researchers observed higher thrombosis rates with self-expanding covered stent grafts compared with BMS (22.2% of those with thrombosis vs. 7.1% of those without; P = .02).
Stent thrombosis significantly increased risk for major adverse limb events, including repeat revascularization, definite stent thrombosis or major amputation, within 12 months of treatment (HR = 4.99; 95% CI, 2.31-10.77 vs. no thrombosis). Two patients with stent thrombosis experienced MACCE, a composite endpoint including all-cause death, MI, ischemic stroke, CABG or coronary revascularization with PCI, within 12 months.
Results from multivariate analysis indicated associations between increased risk for stent thrombosis and the presence of CTOs (OR = 3.46; 95% CI, 0.98-12.2) or in-stent restenosis lesions (OR = 5.3; 95% CI, 1.83-15.32).
The researchers wrote that their findings represent “the first systematically reported experience of lower extremity peripheral artery [stent thrombosis] to date.” They acknowledged several limitations of the study, including its observational nature, potential selection bias, limited follow-up duration and a lack of radiographic follow-up or information on dual antiplatelet therapy adherence. However, they wrote, “This information may guide providers caring for patients with peripheral artery disease in diagnosing and treating this potentially serious complication of endovascular intervention.” – by Adam Taliercio
Disclosure: Banerjee reports receiving research grants from Boston Scientific and The Medicines Company; consultant/speaker honoraria from Boehringer Ingelheim, Cordis, Gilead, Medtronic, Sanofi and St. Jude; has ownership in Mdcare Global and intellectual property in HygeiaTel. Please see the full study for a list of the other researchers’ relevant financial disclosures.