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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2017 Apr 04

DOI: 10.23736/S0021-9509.17.09946-3


lingua: Inglese

Optical coherence tomography: guided therapy of instent restenosis for Peripheral Arterial Disease

Michael K. LICHTENBERG 1 , Jeffrey G. CARR 2, Jaafer A. GOLZAR 3

1 Vascular Centre Arnsberg Clinic, Arnsberg, Germany; 2 Cardiovascular Associates of East Texas, Tyler, TX, USA; 3 Advocate Health Care, Oak Lown, IL, USA


Approximately 27 million people in Europe and North America currently have peripheral arterial disease (PAD)1. The endovascular treatment of stenosis or blocked peripheral arteries in PAD include percutaneous transluminal angioplasty (PTA) with or without a drug coated balloon, atherectomy (rotational, directional, orbital or laser), and stenting. The development of next generation peripheral stents and drug coated stents have led to the improved treatment of complex SFA lesions, and consequently increased their usage23. Additionally, the technologies developed for PAD intervention have further improved the overall adoption of endovascular procedures leading to increased utilization of stents to address procedural dissections (bail-out stenting), as support scaffolding for complex lesions, and to prevent preventing elastic recoil post balloon angioplasty. For example, bail-out stenting after drug-coated balloon angioplasty has been reported to be as high as 40% in long lesions and as high as 46% in CTO lesions4. In total, approximately 200,000 stents are placed annually in the femoral and popliteal arteries in PAD patients in the U.S, with 30% to 40% of these stents expected to develop in-stent restenosis within 2-3 years of implantation5. Accordingly, the treatment of in-stent restenosis (ISR) remains a substantial healthcare burden. Few technologies reported on improved ISR patency rates as compared to PTA treatment alone, including drug eluting stents and balloons, laser atherectomy or covered stents6,7. However, the reported longer-term patency for ISR remains suboptimal8 creating a cyclical treatment pattern that burdens patients and providers9. In this review, we present the rational and clinical evidence for utilizing OCT-guided therapies for the treatment of in-stent restenosis (ISR) for PAD.

KEY WORDS: Instent restenosis - Debulking therapy - Drug coated balloon - OCT guided therapy

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