Abstract 11518: Stent Edge Dissection and Tiny Reference Vessel Area are Related to Target Lesion Revascularization After Self-expanding Nitinol Stent Implantation in the Superficial Femoral Artery
Background: Previous intravascular ultrasound (IVUS) studies reported that tiny reference vessel cross-sectional area (CSA), stent under-expansion, stent asymmetry, edge dissection, and tissue protrusion were associated with target lesion revascularization (TLR) after coronary stenting. We investigated whether these findings apply to superficial femoral artery (SFA) lesions after endovascular therapy.
Methods: We analyzed 236 SFA lesions in consecutive 184 patients who underwent IVUS after self-expanding nitinol stent deployment. The IVUS measurements were performed at 4 sites: minimal stent CSA site, maximal stent CSA site, distal reference site, and proximal reference site. Stent expansion ratio was defined as minimum stent CSA / reference lumen CSA. Radial stent symmetry index was minimum/maximum stent diameter. Axial stent symmetry index was minimum/maximum stent CSA. Stent edge dissection was defined as a tear in the plaque parallel to the vessel wall. TLR was defined as clinically driven revascularization with ≥75% restenosis of the target lesion. Multivariate analysis was performed to identify the independent predictor of TLR.
Results: Clinical follow-up was obtained from all patients with the mean period of 34±15 months. During this period, TLRs were performed in 42 lesions (17.8%). Univariate analysis is shown in the Table. Multivariate analysis revealed that total stent length (HR=4.18, p<0.05), distal reference EEM CSA (HR=9.97, p<0.01), and stent edge dissection (HR=10.84, p<0.01) were independent predictors of TLR.
Conclusion: Stent implantation in the tiny vessel and stent edge dissection in the SFA lesions were high-risk of TLR. However, post-procedural stent under-expansion and stent asymmetry were not associated with TLR. There is no clinical impact of stent over-expansion on long-term outcomes after self-expanding nitinol stent implantation in the SFA lesions.
- © 2012 by American Heart Association, Inc.