Factors Influencing in-Stent Occlusion after Femoropopliteal Artery Stent Placement with Intravascular Ultrasound Evaluation.

PURPOSE: To investigate the rate and predictors of in-stent occlusion by intravascular ultrasound (IVUS) following femoropopliteal artery stent placement.

MATERIALS AND METHODS: From July 2012 to June 2016, this study retrospectively investigated 191 cases of de novo femoropopliteal artery lesions (lesion length, 170 ± 97 mm; chronic total occlusion, 51%) evaluated by IVUS in 162 patients with peripheral artery disease (with critical limb ischemia of 27%) who underwent endovascular therapy using self-expanding nitinol stents. Examination by IVUS was performed to record data for vessel characteristics immediately after wire crossing and at the end of the procedure. The primary outcome measurement was the occurrence of in-stent occlusion, defined as the absence of blood flow at the treatment site by duplex ultrasonography. Predictors for in-stent occlusion were also evaluated by multivariate analysis.

RESULTS: In-stent occlusion was observed in 15% (n = 28) of lesions, and the mean follow-up time was 19 ± 13 months. After multivariate analysis, it was found that plaque burden ≥60% after stent placement (P < .001), female gender (P = .002), and Trans-Atlantic Inter-Society Consensus (TASC) II classification C and D lesions (P = .047) were significantly associated with the occurrence of in-stent occlusion.

CONCLUSIONS: Plaque burden ≥60% after stent placement, female gender, and TASC II classification C/D lesions were significantly associated with the occurrence of in-stent occlusion after femoropopliteal artery stent placement as evaluated by IVUS.