Cath Lab Digest

While it is true that devices and techniques have evolved considerably over the past several years, and endovascular treatment has been propelled to first-line therapy in most cases today, there is no doubt that in-stent restenosis (ISR) remains a significant and largely unresolved issue.

Tosaka et al published an important article containing interesting information on the subject in the current issue of JACC.¹ The article is followed by an insightful editorial written by Laird and Yeo.² Not surprisingly, it would seem that the type and extent of an ISR lesion predict the risk of recurrent restenosis after treatment—anywhere from 50% to 85% at 2 years! A good number of patients wind up necessitating bypass surgery and in all cases, the treatment of ISR involved prolonged-inflation PTA.

Not sure what most interventionists do today when faced with a significant ISR lesion after SFA stenting, but I continue to treat most with PTA and—frequently—re-stenting. I tried a number of other therapies over time… and continue to come back to “traditional” PTA/stenting because it is easy to do and predictable in terms of technical results without the complexities of other available devices. Moreover, we have no good evidence in support of anything else for such lesions.

What do you do in your practice?

References

1. Tosaka A, Soga Y, Lida O, et al. Classification and Clinical Impact of Restenosis After Femoropopliteal Stenting. JACC. 2012 Jan;59(1):16-23.
2. Laird JR, Yeo KK. The Treatment of Femoropopliteal In-Stent Restenosis: Back to the Future. JACC. 2012 Jan;59(1):24-25.