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TCTAP A-131 Distal Vessel Diameter Is Predictor of Stent Restenosis in the TASC C, D Lesions of Femoropopliteal Artery
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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
large bony tumors in anatomically difficult locations. It decreases the blood loss significantly when used preoperatively inoperable tumors. TCTAP A-131 Distal Vessel Diameter Is Predictor of Stent Restenosis in the TASC C, D Lesions of Femoropopliteal Artery Hiroaki Nakamura,1 Makoto Kadotani,2 Atsusuke Yatomi,1 Yasuhiro Kaetsu1 1 Kakogawa Central City Hospital, Japan; 2Kakogawa East City Hospital, Japan BACKGROUND Endovascular treatment for the long femoropopliteal lesions has not substantial result. This study purpose to evaluate the predictor of primary patency and freedom from target lesion re-intervention in the complex lesions with a femoropopliteal artery. METHODS Between August 2011 and June 2015, 68 patients (48 men; 73 8 years) 83 lesions with symptomatic TASCC or D class were treated by endovascular intervention. We measured vessel diameter using intravascular ultrasonography (IVUS). At 12 months post-intervention, clinical symptom, ABI, X-ray, and peak systolic velocity ratio (PSVR) of the duplex scan was estimated. Primary patency was defined as PSVR＜2.5. RESULTS Hemodialysis 15%. Rutherford class 1-3: 70%, 4: 5%, 5: 22%, 6: 4%. ABI 0.60 0.14. Mean length was 242 56 mm. Mean proximal and distal vessel diameter 6.8 1.0 mm, 5.8 0.9 mm. Chronic total occlusion was 64 vessels (77%). TASC C was 34 lesions (41%), and D was 49 lesions (59%). BMS and DES were implanted in 63 and 20 lesions. Primary and secondary patency were recorded in 71%, 82% lesions. Freedom from target lesion re-intervention (TLR) was 81% at 12 months post procedure. In the distal vessel diameter <6 mm, primary patency was 53%. It was >6 mm, primary patency was 71%. There was a significant difference between 2 groups. Stent fractures were 7.2%. CONCLUSION Primary patency with distal vessel diameter<6 mm was significantly lower than it >6 mm. Distal vessel diameter is predicted or of stent restenosis in complex femoropopliteal arterial disease. IVUS is a useful tool to predict primary patency, and select the stent size, kind. TCTAP A-132 Impact of Stent Diameter on Stent Patency After Self-expanding Nitinol Stent Implantation in the Superficial Femoral Artery Kojiro Miki,1 Hirokuni Akahori,1 Tohru Masuyama,1 Masaharu Ishihara2 1 Hyogo College of Medicine, Japan; 2National Cerebral and Cardiovascular Center, Japan BACKGROUND The optimal sizing of self-expanding nitinol stents in the treatment of superficial femoral artery (SFA) lesions is unclear. This study sought to investigate the influence of stent diameter on the patency for SFA lesions using optical coherence tomography (OCT). METHODS De novo SFA lesions in patients who underwent selfexpanding nitinol stents implantation were enrolled. Follow-up angiography and OCT was conducted to assess stent patency six months after stent implantation, and volumetric OCT analysis was performed to evaluate vascular response to the stents. Volume index (VI) was defined as the volume divided by the stent length. The primary end point was lumen VI at the 6-month follow-up. A secondary endpoint was minimum lumen area (MLA) at the follow-up. RESULTS A total of 40 SFA lesions treated with self-expanding nitinol stents (6-mm diameter stents in 18 lesions, 7-mm diameter stents in 12 lesions, and 8-mm diameter stents in 10 lesions) were analyzed. Mean stent length was 85.3 32.7 mm. Baseline characteristics and angiographic data were similar among the three different stent diameter (6-mm, 7-mm, and 8-mm) groups. MLA at the 6-month follow-up was 9.7 2.7 mm 2 in the 6-mm group, 12.2 3.9 mm2 in the 7-mm group, and 13.9 6.4 mm2 in the 8-mm group (p<0.05 for one-way ANOVA, p<0.05 for trend). Volumetric OCT parameters at the follow-up are presented in Figure 1. Stent VI was greater in the larger stent diameter groups (p<0.01 for one-way ANOVA, p<0.01 for trend). Neointimal VI was similar among the three groups (p¼0.19 for one-way ANOVA, p¼0.43 for trend). As a result, lumen VI was greater in the larger stent diameter groups (p<0.05 for one-way ANOVA, p<0.05 for trend).
CONCLUSION Chronic stent enlargement resulted in greater lumen area after implantation of self-expanding nitinol stents with a larger diameter. The sizing of stent diameter might be important for stent patency in SFA lesions. TCTAP A-133 Hemostatic Complication Caused by Transpopliteal Retrograde Approach with Angiography-guided Puncture in the Supine Position Kenji Yanishi,1 Kan Zen,1 Osami Kawarada,2 Naohiko Nakanishi,1 Takeshi Nakamura,1 Satoaki Matoba1 1 Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine, Japan; 2National Cerebral and Cardiovascular Center, Japan BACKGROUND Trans popliteal retrograde approach is often used simultaneously in the endovascular therapy (EVT) for the femoropopliteal chronic occlusive diseases (CTOs) and puncturing popliteal artery in a supine position is supposed to be reasonable. Although that kind of procedure has potential concerns about hemostasis like arteriovenous (AV) fistula or hematoma, their frequencies and severities have not been known in detail. METHODS This registry was a prospective, multicenter study. A total of 47 patients (35 men; mean age 76 years) were enrolled. They underwent an EVT for femoropopliteal CTO using a trans popliteal retrograde approach with angiographic guidance in the supine position. A small-size sheath of three or four French (Fr) in diameter was inserted into the popliteal artery in all patients, and hemostasis was conducted with a
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
large bony tumors in anatomically difficult locations. It decreases the blood loss significantly when used preoperatively inoperable tumors. TCTAP A-131 Distal Vessel Diameter Is Predictor of Stent Restenosis in the TASC C, D Lesions of Femoropopliteal Artery Hiroaki Nakamura,1 Makoto Kadotani,2 Atsusuke Yatomi,1 Yasuhiro Kaetsu1 1 Kakogawa Central City Hospital, Japan; 2Kakogawa East City Hospital, Japan BACKGROUND Endovascular treatment for the long femoropopliteal lesions has not substantial result. This study purpose to evaluate the predictor of primary patency and freedom from target lesion re-intervention in the complex lesions with a femoropopliteal artery. METHODS Between August 2011 and June 2015, 68 patients (48 men; 73 8 years) 83 lesions with symptomatic TASCC or D class were treated by endovascular intervention. We measured vessel diameter using intravascular ultrasonography (IVUS). At 12 months post-intervention, clinical symptom, ABI, X-ray, and peak systolic velocity ratio (PSVR) of the duplex scan was estimated. Primary patency was defined as PSVR＜2.5. RESULTS Hemodialysis 15%. Rutherford class 1-3: 70%, 4: 5%, 5: 22%, 6: 4%. ABI 0.60 0.14. Mean length was 242 56 mm. Mean proximal and distal vessel diameter 6.8 1.0 mm, 5.8 0.9 mm. Chronic total occlusion was 64 vessels (77%). TASC C was 34 lesions (41%), and D was 49 lesions (59%). BMS and DES were implanted in 63 and 20 lesions. Primary and secondary patency were recorded in 71%, 82% lesions. Freedom from target lesion re-intervention (TLR) was 81% at 12 months post procedure. In the distal vessel diameter <6 mm, primary patency was 53%. It was >6 mm, primary patency was 71%. There was a significant difference between 2 groups. Stent fractures were 7.2%. CONCLUSION Primary patency with distal vessel diameter<6 mm was significantly lower than it >6 mm. Distal vessel diameter is predicted or of stent restenosis in complex femoropopliteal arterial disease. IVUS is a useful tool to predict primary patency, and select the stent size, kind. TCTAP A-132 Impact of Stent Diameter on Stent Patency After Self-expanding Nitinol Stent Implantation in the Superficial Femoral Artery Kojiro Miki,1 Hirokuni Akahori,1 Tohru Masuyama,1 Masaharu Ishihara2 1 Hyogo College of Medicine, Japan; 2National Cerebral and Cardiovascular Center, Japan BACKGROUND The optimal sizing of self-expanding nitinol stents in the treatment of superficial femoral artery (SFA) lesions is unclear. This study sought to investigate the influence of stent diameter on the patency for SFA lesions using optical coherence tomography (OCT). METHODS De novo SFA lesions in patients who underwent selfexpanding nitinol stents implantation were enrolled. Follow-up angiography and OCT was conducted to assess stent patency six months after stent implantation, and volumetric OCT analysis was performed to evaluate vascular response to the stents. Volume index (VI) was defined as the volume divided by the stent length. The primary end point was lumen VI at the 6-month follow-up. A secondary endpoint was minimum lumen area (MLA) at the follow-up. RESULTS A total of 40 SFA lesions treated with self-expanding nitinol stents (6-mm diameter stents in 18 lesions, 7-mm diameter stents in 12 lesions, and 8-mm diameter stents in 10 lesions) were analyzed. Mean stent length was 85.3 32.7 mm. Baseline characteristics and angiographic data were similar among the three different stent diameter (6-mm, 7-mm, and 8-mm) groups. MLA at the 6-month follow-up was 9.7 2.7 mm 2 in the 6-mm group, 12.2 3.9 mm2 in the 7-mm group, and 13.9 6.4 mm2 in the 8-mm group (p<0.05 for one-way ANOVA, p<0.05 for trend). Volumetric OCT parameters at the follow-up are presented in Figure 1. Stent VI was greater in the larger stent diameter groups (p<0.01 for one-way ANOVA, p<0.01 for trend). Neointimal VI was similar among the three groups (p¼0.19 for one-way ANOVA, p¼0.43 for trend). As a result, lumen VI was greater in the larger stent diameter groups (p<0.05 for one-way ANOVA, p<0.05 for trend).
CONCLUSION Chronic stent enlargement resulted in greater lumen area after implantation of self-expanding nitinol stents with a larger diameter. The sizing of stent diameter might be important for stent patency in SFA lesions. TCTAP A-133 Hemostatic Complication Caused by Transpopliteal Retrograde Approach with Angiography-guided Puncture in the Supine Position Kenji Yanishi,1 Kan Zen,1 Osami Kawarada,2 Naohiko Nakanishi,1 Takeshi Nakamura,1 Satoaki Matoba1 1 Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine, Japan; 2National Cerebral and Cardiovascular Center, Japan BACKGROUND Trans popliteal retrograde approach is often used simultaneously in the endovascular therapy (EVT) for the femoropopliteal chronic occlusive diseases (CTOs) and puncturing popliteal artery in a supine position is supposed to be reasonable. Although that kind of procedure has potential concerns about hemostasis like arteriovenous (AV) fistula or hematoma, their frequencies and severities have not been known in detail. METHODS This registry was a prospective, multicenter study. A total of 47 patients (35 men; mean age 76 years) were enrolled. They underwent an EVT for femoropopliteal CTO using a trans popliteal retrograde approach with angiographic guidance in the supine position. A small-size sheath of three or four French (Fr) in diameter was inserted into the popliteal artery in all patients, and hemostasis was conducted with a