Journal of Endovascular Therapy最新文献

{"title":"Treatment of Calcified Femoro-Popliteal Lesions Using Jetstream^® Atherectomy Device and Ranger^® Drug-Coated Balloon Without Embolic Protection Device: 12-Month Results of the Ellipse Multicenter Study.","authors":"Nicolas Valerio, Jerome Albertin, Nicolas Louis, Jean-Noel Albertini","doi":"10.1177/15266028251352788","DOIUrl":"10.1177/15266028251352788","url":null,"abstract":"<p><strong>Introduction: </strong>Endovascular treatment of complex femoro-popliteal lesions using plain angioplasty balloon and bare stents carries a high incidence of in-stent restenosis. Debulking using atherectomy device followed by angioplasty with drug coated balloon (DCB) has been proposed as an alternative option. However, few reports have published midterm outcomes and were focused on large inclusion criteria. The aim of this multicenter study was to report 12-month freedom from target lesion revascularization (TLR) following treatment of Trans-Atlantic Inter-Society Consensus (TASC) B and C femoro-popliteal lesions using JetStream<sup>®</sup> rotational plus aspiration atherectomy device and Ranger<sup>®</sup> DCB (Boston Scientific, Marlborough, MA, USA).</p><p><strong>Methods: </strong>Between March 2020 and December 2021, consecutive patients from 8 centers, with de novo and calcified TASC B and C lesions of superficial femoral artery and/or above-knee popliteal arteries were included. Intra-stent restenosis and recent (<1 month) occlusions were excluded. All patients had disabling intermittent claudication (Rutherford class 2 and 3). Procedure was 2 steps: atherectomy using Jetstream and postdilatation using drug-coated Ranger balloon. No embolic protection device was used. Patients who had target lesion stenting were excluded.</p><p><strong>Results: </strong>Fifty-eight patients signed informed consent and underwent the procedure. Two patients underwent stenting of the target lesion. Two had failure to cross the lesion. Fifty-four patients had the full procedure [technical success 93% (54/58)]. Postoperative course was uneventful in all patients, and no embolic event was observed. During follow-up, 2 patients died, and 5 were lost to follow-up. Forty-seven patients had complete 12 months clinical and duplex follow-up. Two patients had target lesion restenosis, respectively, at 3 and 9 months, which were treated by balloon angioplasty. Kaplan-Meier 12-month freedom from TLR was 96% ± 3% (95% confidence interval 0.9-1).</p><p><strong>Conclusion: </strong>Treatment of complex femoro-popliteal lesions using rotational atherectomy and DCB without embolic protection is safe and effective with high technical success rate, no postoperative embolic events, and satisfactory 12-month freedom from TLR.Clinical ImpactThe Ellipse study was a multicenter prospective observational trial on the treatment of calcified TASC B and C lesions using Jetstream atherectomy and Ranger drug-coated balloon with no embolic protection. This technique resulted in 93% technical success and no distal embolization. Twelve-month freedom from target lesion revascularization, primary and secondary patency were, respectively, 96% ± 3%, 94% ± 4%, and 98% ± 2%. Rotational atherectomy plus drug coated balloon is a safe and effective treatment of complex calcified femoro-popliteal lesions. Embolic protection might not be necessary in selected patients, when lesions at high","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2561-2568"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-Vivo Optical Spectroscopy (INVOS) as a Prognostic Tool for Peripheral Artery Disease During Endovascular Intervention: A Pilot Study.","authors":"David T McGreevy, Tal M Hörer, Marcelo H Petri","doi":"10.1177/15266028251380182","DOIUrl":"10.1177/15266028251380182","url":null,"abstract":"<p><strong>Introduction: </strong>Peripheral arterial disease (PAD), including intermittent claudication (IC) or critical limb ischemia (CLI), can be treated with endovascular revascularization; however, tools for intraoperative prognostication are limited. The In-Vivo Optical Spectroscopy (INVOS) system, a non-invasive near-infrared spectroscopy device, measures tissue oxygenation. This pilot study aims to investigate the use of INVOS during endovascular surgery for PAD as a prognostic tool for endovascular PAD treatment. This study is intended as a feasibility and hypothesis-generating pilot, rather than one designed to draw definitive conclusions.</p><p><strong>Methods: </strong>Thirty patients with PAD undergoing endovascular treatment were prospectively enrolled. In-Vivo Optical Spectroscopy sensors were applied to the treated foot preoperatively. Measurements were recorded preoperatively, postoperatively, and at 1, 2, and 3 hours post-surgery. Raw INVOS values and INVOS/systolic blood pressure (SBP) ratios were calculated and normalized to baseline values to determine fold changes. Clinical outcomes were assessed at 30 days.</p><p><strong>Results: </strong>No significant changes in raw INVOS or SBP values were observed before or after the procedure in both IC and CLI groups. However, the normalized INVOS/SBP ratio was significantly higher in IC patients at 1 and 2 hours postoperatively (p<0.05). A fold change greater than 1.25 was associated with better clinical outcomes, including fewer complications and higher rates of patient- and physician-reported improvement.</p><p><strong>Conclusion: </strong>An INVOS/SBP ratio fold change greater than 1.25-fold is associated with improved outcomes following endovascular intervention for PAD. In-Vivo Optical Spectroscopy may serve as a valuable intraoperative prognostic tool, particularly in IC patients. Further studies are needed to validate these findings.Clinical ImpactThe clinical impact of the current work is to improve the knowledge in the application of INVOS measurements peri operative in clinical practices and improve patients care. Post operative surveillance with INVOS could be used to confirm surgical success. INVOS ratio lower than 1.25-fold after first revascularization should be reassessed and improve blood flow towards the limb. Although limited, this pilot study shows that the use of INVOS can be an adjuvanted tool in monitoring surgical outcomes in patients with PAD.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2771-2776"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor on \"Results of Palliative Stenting in Malignant Superior Vena Cava Syndrome Analyzing Self-expanding Stainless Steel and Nitinol Venous Bare Metal Stents\".","authors":"Yi Deng, Wei Cui, Jing Li","doi":"10.1177/15266028251316141","DOIUrl":"10.1177/15266028251316141","url":null,"abstract":"","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2777-2778"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inferior Vena Cava Filter Placed in Neurologic Intensive Care Unit: Effectiveness, Retrieval Rate, and Mortality.","authors":"Qian Yu, Patrick Tran, Monika Neale, Lauren Singer, Jonathan Fergus, Wesley Lim, Waseem Wahood, Rakesh Navuluri, Osman Ahmed, Thuong Van Ha","doi":"10.1177/15266028251325088","DOIUrl":"10.1177/15266028251325088","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Patients in neurologic intensive care unit (NICU) often undergo inferior vena cava filter (IVCF) placement for venous thrombotic events. This study aims to determine the effectiveness of IVCF, filter retrieval, and mortality among patients that received IVCF in NICU.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;In this single institutional, noncomparative, retrospective study, all patients who were admitted to NICU and underwent IVCF placement from April 2015 to December 2020 were reviewed. IVCF was successfully deployed in all 175 patients [100%; median age 68 years, female 84/175 (48.0%)]. The 3 most common causes for NICU admission were intracranial hemorrhage (66/175, 37.7%), ischemic stroke (62/175, 35.4%), and traumatic brain injury (16/175, 9.1%). Deep vein thrombosis and pulmonary embolism (PE) were confirmed in 155 (88.6%) and 35 (20.0%) patients at the time of filter placement, respectively. Primary outcomes of interest were postfilter placement PE, filter retrieval, and inhospital mortality. Baseline characteristics were analyzed using &lt;i&gt;t&lt;/i&gt;-tests and chi-squared test for continuous and noncontinuous variables, respectively. Factors associated with primary outcomes were analyzed with a logistic regression model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Post-IVCF PE occurred in 3 patients (1.7%) with a median follow-up of 3 months. Excluding 26 inhospital deaths (14.9%, none was related to PE), filters were retrieved in 31 discharged patients (20.8%) with a median filter dwelling time of 9 months. Advanced filter retrieval required a higher fluoroscopy time (median 3.3 minutes vs 8.3 minutes, p = 0.016) and contrast volume use (median 35.0 ml vs 57.5 ml, p = 0.0028) than standard technique. No procedure-related complication occurred during filter placement and retrieval. Sequential Organ Failure Assessment (SOFA, p = 0.012) and Simplified Acute Physiology Scores (SAPS, p = 0.016) were independently associated with inhospital mortality. Modified Rankin Score (mRS) at discharge was an independent predictor for filter retrieval (p &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Despite safety and effectiveness, IVCF retrieval rate for NICU patients was low, particularly those with worse mRS at time of hospital discharge. Worse SOFA and SAPS scores were associated with inhospital mortality.Clinical ImpactInferior vena cava filter (IVCF) is effective preventing post-filter pulmonary embolism (PE) in neurologic intensive care unit (NICU) patients, with only 1.7% experiencing PE post-placement, underscoring its role in managing venous thrombotic events in this high-risk population; however, the low retrieval rate of IVCFs, particularly in patients with poorer functional outcomes (worse mRS at discharge), and the association of higher SOFA and SAPS scores with increased inhospital mortality, emphasize the need for improved strategies to optimize filter retrieval and patient selection in critically ill neurologic patients.&lt;/","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2414-2420"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Superior Mesenteric Artery Embolism With Infective Endocarditis: Is There a Role for Endovascular Treatment?","authors":"Xiaoxiang Zhou, Jiao Teng, Zhenjiang Li, Qinglong Zeng, Yangyan He, Yunjun He, Yilang Xiang, Ziheng Wu, Dongling Li, Lu Tian, Hongkun Zhang, Qianqian Zhu","doi":"10.1177/15266028241300927","DOIUrl":"10.1177/15266028241300927","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this article is to report a case of acute superior mesenteric artery embolism due to infective endocarditis treated with endovascular therapy.</p><p><strong>Case report: </strong>A patient with infective endocarditis was admitted to the hospital with abdominal pain, and abdominal enhanced computer tomography showed acute superior mesenteric artery embolism. He underwent urgent percutaneous mechanical thrombectomy and stenting to open the superior mesenteric artery and restore blood supply to the intestine. However, 17 days after the endovascular treatment, a pseudoaneurysm formed next to the stent, which was eventually removed by open surgery. The patient's prognosis was good at the 1 year follow-up.</p><p><strong>Conclusion: </strong>Endovascular treatment of acute superior mesenteric artery embolism caused by infective endocarditis was able to rapidly restore the intestinal blood supply. However, the possibility of postoperative pseudoaneurysm needs to be guarded against.Clinical ImpactThis study will provide clinical treatment guidance for acute superior mesenteric artery embolism caused by infectious endocarditis. Endovascular treatment may rapidly alleviate intestinal ischemia and reduce the risk of intestinal necrosis, but it cannot completely eliminate infectious emboli, which may lead to further development of pseudoaneurysms.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2757-2762"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Long-Term Cardiovascular and All-Cause Mortality Following Elective Infrarenal Repair of the Abdominal Aortic Aneurysm: A Systematic Review and Meta-Analysis.","authors":"Larry E Miller","doi":"10.1177/15266028251350073","DOIUrl":"10.1177/15266028251350073","url":null,"abstract":"","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2779-2780"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Hemodynamic Predictors of Aortic Growth After Thoracic Endovascular Aortic Repair for Type B Aortic Dissection.","authors":"Yonghui Chen, Jiayin Guo, Shuaishuai Wang, Yan Song, Xiangchen Dai","doi":"10.1177/15266028251352799","DOIUrl":"10.1177/15266028251352799","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To explore independent predictors of aortic growth in patients with type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR), utilizing computational fluid dynamics (CFD) simulation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Patients who underwent TEVAR for TBAD in a single center between April 2014 and April 2023 were evaluated retrospectively. Rapid enlargement (defined as ≥5 mm/year) or aortic rupture were used to categorize patients into aortic growth and nongrowth groups. The analyzed hemodynamic parameters included wall pressure, flow velocity, flow rate, wall shear stress (WSS), time-averaged WSS, oscillatory shear index (OSI), and relative residence time. Four parallel cross-sections (L1-L4) were utilized to extract data from the hemodynamic cloud maps. Multivariate logistic regression analysis was conducted to identify independent predictors. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) for these predictors were also determined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The aortic growth rate was 17.9%. A total of 51 geometric models were successfully constructed, 17 in the growth group and 34 in the nongrowth group. For morphological variables, the growth group exhibited more re-entry tears (p=0.011) and a longer patent false lumen (p=0.028), compared with the nongrowth group. For hemodynamic variables, the growth group had higher L2 pressure (p=0.040), L3 flow rate (p=0.048), and L3 OSI (p=0.020). Multivariate analysis revealed that L3 OSI (OR=7.82, 95% CI 4.122-11.33, p=0.020) and L2 pressure (OR=1.05, 95% CI 1.001-1.099, p=0.044) were independent risk factors for aortic growth. The AUC for L3 OSI and L2 pressure as predictors of aortic growth were 68.25% (95% CI 53.85-82.66) and 64.36% (95% CI 49.13-79.59), respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;CFD simulation demonstrated that elevated pressure and increased OSI in false lumen could independently predict aortic growth following TEVAR. Monitoring these specific metrics could help identify high-risk patients immediately after stent graft implantation. However, the predictive value of these predictors was low, indicating a need for larger sample, higher-quality studies to validate these findings.Clinical ImpactThoracic endovascular aortic repair (TEVAR) is the important treatment for patients with acute type B aortic dissection (TBAD). However, aortic growth following TEVAR remains an important unresolved issue. Previous case/ cases reports found aortic growth was not solely driven by anatomical factors but influenced by hemodynamics within the false lumen. However, no further higher-quality studies supported the conclusion. In this comparative study, aortic growth and non-growth groups were divided. The computational fluid dynamics (CFD) simulation showed that elevated pressure and oscillatory shear index (OSI) in the false lumen could independently predict aortic growth after TEVAR. Our ","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2569-2581"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter by Autiero G. et al regarding the Article: Yu Q et al Inferior Vena Cava Filter Placed in Neurologic Intensive Care Unit: Effectiveness, Retrieval Rate, and Mortality.","authors":"Giuliana Autiero, Elisabetta Grolla, Francesca Vittone, Michele Dalla Vestra","doi":"10.1177/15266028251379814","DOIUrl":"10.1177/15266028251379814","url":null,"abstract":"","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2783-2784"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Assessment of Changes in Target Vessel Peak Systolic Velocity Measurements After Fenestrated-Branched Endovascular Aortic Repair.","authors":"Titia A L Sulzer, Thanila A Macedo, Thomas Mesnard, Emanuel R Tenorio, Guilherme Baumgardt Barbosa Lima, Heather Hatz, Gina K Hesley, Alexander Lekah, Tiziano Tallarita, Ying Huang, Bernardo C Mendes, Gustavo S Oderich","doi":"10.1177/15266028251368250","DOIUrl":"10.1177/15266028251368250","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Target vessel stenosis or occlusion is a common indication for secondary intervention after fenestrated-branched endovascular aortic repair requiring long-term imaging surveillance including duplex ultrasound (DUS). This study aimed to describe and compare longitudinal changes in peak systolic velocity (PSV) measurements for renal and mesenteric arteries targeted by directional branches (DBs) or reinforced fenestrations (RFs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients enrolled in a prospective, nonrandomized study (2013-2020) had DUS of celiac axis, superior mesenteric artery, and renal arteries (RAs) obtained preoperatively, at 6 to 8 weeks, 6 months, and annually. Vessels with preprocedural stenosis were excluded. Outcomes were variations in PSV over time for target vessels incorporated by DBs or RFs, differences in balloon-expandable stent-grafts (BESGs) and self-expandable stent-grafts (SESGs), PSV measurements prior to secondary interventions related to vessel stenosis, and a predictive value of PSV for stenosis requiring secondary intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 419 patients (292 male, mean age 74 ± 8 years old) were enrolled, with 1,311 target vessels analyzed preoperatively, including 607 mesenteric and 704 RAs. Over a median follow-up of 23 months (interquartile range [IQR], 7-36), PSV measurements decreased in the first 6 to 8 weeks after DB incorporation, remained stable, followed by a nonsignificant increase at 5 years. PSV increased in the first 6 months using RFs with postoperative velocities significantly higher (&lt;i&gt;P&lt;/i&gt; &lt; .05) for RFs compared to DBs. Branched mesenteric vessels stented with BESGs had higher velocities than SESGs (&lt;i&gt;P&lt;/i&gt; &lt; .05). Of the 23 target vessels treated by secondary intervention for stenosis, 19 (83%) had velocities above the thresholds for native, nonstented vessels. Furthermore, in RAs (n = 20) PSV effectively predicted clinically relevant stenosis, AUC was 0.98, with a 231 cm/s threshold offering 84% sensitivity with 100% specificity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Longitudinal follow-up shows that velocity changes vary depending on the type of incorporation, vessel, and bridging stent. For DBs, PSV decreased initially, stabilized, and showed a nonsignificant increase at 5 years. In contrast, PSV increased with RFs and remained higher than DBs. Despite these variations, velocities remained below established thresholds for clinically significant stenosis in nonstented vessels. Criteria for in-stent stenosis may differ, and PSV alone should not be the sole indicator for reintervention.Clinical ImpactThis study provides new insight into duplex ultrasound (DUS) surveillance after fenestrated and branched endovascular aneurysm repair (FB-EVAR). Peak systolic velocity (PSV) trends differed between fenestrations and branches, and stent type influenced flow dynamics. Importantly, most vessels with secondary interventions had elevated PSVs, but many o","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2645-2656"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Endovascular Therapy Using Excimer Laser Atherectomy for Complex Femoropopliteal In-Stent Restenosis Lesions.","authors":"Kazunori Horie, Mitsuyoshi Takahara, Shin Takiuchi, Shin Okamoto, Naoki Yoshioka, Nobuhito Kaneko, Kenji Ogata, Yoshiaki Shintani, Takuya Haraguchi, Kuniyasu Ikeoka, Tomoko Kobayashi, Kenji Suzuki, Kuniyoshi Fukai, Yuki Shima, Masahiro Iiya, Norio Tada, Osamu Iida","doi":"10.1177/15266028251363466","DOIUrl":"10.1177/15266028251363466","url":null,"abstract":"<p><strong>Purpose: </strong>The guidelines recommend excimer laser atherectomy (ELA) for in-stent restenosis (ISR) lesions in femoropopliteal arteries. However, its efficacy is still unknown in ISR related to scaffolds other than bare-metal stent (BMS). This study aimed to evaluate the 1-year clinical outcomes in patients with femoropopliteal ISR lesions treated with endovascular therapy (EVT) using ELA.</p><p><strong>Materials and methods: </strong>This retrospective multicenter registry analyzed patients who presented with peripheral artery disease caused by femoropopliteal ISR lesions undergoing EVT with ELA between 2020 and 2024. The primary outcome was re-restenosis 1-year following EVT.</p><p><strong>Results: </strong>Overall, consecutive 166 patients with femoropopliteal ISR lesions were enrolled. The rates of in-stent occlusion and ISR related to scaffolds other than BMS were found in 88.6% and 52.4% of the lesions, respectively. Technical success was achieved in 83.7%. The 1-year Kaplan-Meier estimate of freedom from re-restenosis was 67.6% (95% confidence interval [CI] 60.0-75.5). The primary-assisted patency and secondary patency rate was 72.7% (95% CI 65.8-80.3) and 81.5% (95% CI 76.6-88.0), respectively. In the multivariate analysis, slow flow observed in the completion angiography of EVT (adjusted hazard ratio, 2.32; <i>P</i> = .024) and chronic renal failure requiring dialysis (1.72; <i>P</i> = .036) were independently associated with re-restenosis risk. The accumulation of these factors was associated with a lower rate of freedom from re-restenosis; Kaplan-Meier estimates of the rates were 46.6% in subgroups with 1 or 2 risk factors, whereas it was 77.8% in the absence of risk factors. The Kaplan-Meier estimate shows a comparable primary patency rate between ISR related to BMS and drug-eluting stent at 1 year.</p><p><strong>Conclusion: </strong>ELA provided acceptable technical success in current femoropopliteal ISR lesions; however, the long-term result was clinically suboptimal.Clinical ImpactThis retrospective multicenter registry enrolled 166 patients with in-stent restenosis/in-stent occlusion lesions in femoropopliteal arteries treated with endovascular therapy using excimer laser atherectomy. The technical success rate was acceptable at 83.7%; however, 1-year estimate of freedom from restenosis was clinically suboptimal at 67.6%. The multivariate analysis showed incomplete antegrade blood flow and dialysis-dependent chronic renal failure were independently associated with re-restenosis risk.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2600-2608"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}