1. Restenosis in Peripheral Arteries
Donald B Reid
Glasgow, Scotland

2. No Disclosures

3. Definition Recurrent stenosis in a vessel following treatment
Reduction in the circumference of more than 50% of vessel wall

4. Journal of Endovascular Therapy

5. Endovascular Restenosis
Fishmouth

6. Histopathology of Restenosis
Two major mechanisms
Early : trauma to vessel wall triggers the clotting cascade to form a thrombus
Late : restenosis where normal mechanisms which limit inflammation fail leading to fibroproliferative reaction and neointimal hyperplasia

7. Aetiology Age Diabetes Small vessels Renal failure Women
Previous restenosis
Altered haemodynamic factors
Bio-incompatibility of graft or stent materials

8. Anatomical Features
Carotid artery
Iliac artery
Femoral artery

9. Investigations Clinical examination Doppler ultrasound CTA (MRA)
Arteriography
Intravascular ultrasound
Arterial pressure gradient

10. Femoral Stent Restenosis
Courtesy P Peeters

11. Cryotherapy
PolarCath Balloon

12. Atherectomy
Jetstream Pathway Device

13. Laser for SFA In-Stent Restenosis
PATENT STUDY
Laser for SFA In-Stent Restenosis
Schmidt A, Zeller T, Sievert H et al.
J Endovasc Ther 2014; 21: 52-60

14. “Reline” for In-Stent Restenosis
Fishmouth
Reline Study
Randomised Trial
Viabahn vs PTA

15. Drug Eluting Stents

16. Randomised controlled trial
The SIROCCO Trial
Randomised controlled trial
Sirolimus Smart Stent vs Bare Metal Smart Stent
Duda SH, Bosiers M, Lammer J et al.
J Endovasc Ther 2006; 13:

17. In-Stent Restenosis at 1 year
Drug Eluting Balloons
DEBATE-ISR Study
Paclitaxil DEB vs PTA
19.5% vs %
In-Stent Restenosis at 1 year
P<0.05
Liistro F, Angioli P, Porto I et al.
J Endovasc Ther 2014; 21: 1-8.

18. Restenosis Conclusions
Restenosis is a significant complication after endovascular surgery
Diagnostic Imaging can give Early Detection
Difficult to treat successfully 18

19. Restenosis Conclusions Prevention with risk factor reduction :
Anti-hypertensives, Statins, Anti-platelets
Non Smoking
Drug Eluting Stents and Stent Design 19

20. 20

21. 21

22. Iliac Stent Restenosis
Recurrent symptoms
Clinical Examination
Doppler U/S
CTA
PTA + IVUS

23. Carotid Endarterectomy Restenosis
Carotid Restenosis

24. Carotid Endarterectomy Restenosis

25. Carotid Endarterectomy Restenosis
Post Stent

26. Carotid Endarterectomy Restenosis
A 10 year retrospective study of 192 patients with restenosis following carotid endarterectomy surgery treated by repeat surgery or stenting
Repeat Surgery n = 72
Carotid Stenting n = 120
AbuRhama et al., 2010

27. AbuRhama et al., 2010 30 day Perioperative Results STENT N=120 Total
REPEAT SURG
N=72
STENT
N=120
Total
(N=192)
P value
Ipsilateral Stroke
2 (3%)
1 (1%)
3 (2%)
0.5573
Ipsilateral TIA
3 (3%)
4 (2%) 1
Death MI
Bleeding
1 (0.5%)
Periop complication
14 (19%)
2 (2%)
16 (8%)
<0.0001
Cranial nerve injury
10 (14%)
10 (5%)
AbuRhama et al., 2010

28. AbuRhama et al., 2010 30 day Perioperative Results STENT N=120 Total
REPEAT SURG
N=72
STENT
N=120
Total
(N=192)
P value
Ipsilateral Stroke
2 (3%)
1 (1%)
3 (2%)
0.5573
Ipsilateral TIA
3 (3%)
4 (2%) 1
Death MI
Bleeding
1 (0.5%)
Periop complication
14 (19%)
2 (2%)
16 (8%)
<0.0001
Cranial nerve injury
10 (14%)
10 (5%)
AbuRhama et al., 2010

29. Carotid Restenosis
REPEAT SURGERY
STENT
AbuRhama et al., 2010

30. Carotid Stent Restenosis
Conclusions
Carotid Stent Restenosis
REPEAT
SURGERY
STENT
AbuRhama et al., 2010

31. Atherectomy
Jetstream Pathway Device