June 22, 2006

Predictive Factors Of Patency Following Femoral-Popliteal Arterial Balloon Angioplasty (FPBA) and Stenting: Is Recoil A Bad Sign?

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Anil Hingorani*, Enrico Ascher, Natalie Marks*, Manikyam Mutyala*, Alexander Shiferson*, Theresa Jacob*
Maimonides Medical Center, Brooklyn, NY

Purpose: The role of stenting during FPBA remains poorly understood. Herein, we compare the patency rates of stented versus non-stented cases and the reasons for stenting as potential indicators of success or failure.
Methods: Over the last 27 months we performed 291 duplex-guided FPBA (194 stenoses;97 occlusions) on 244 limbs in 219 patients. Disabling claudication was the indication in 67%. Self-expanding stents were used when plaque dissection and/or recoil caused diameter reduction ≥40%. Serial follow-up duplex scans were obtained. Severe restenosis (>70%) was measured by B-mode and peak systolic velocity ratio >3.
Results: Follow-up ranged from 1 to 27 months(mean 7±6months). Overall mean interval for restenosis and occlusion was 6.4±4.2months and 3.9±4.7months, respectively. As shown in table, stents did affect overall patency results.

	Stented (cases)	Restenosis (%)	P value	Occlusion (%)	P value	Restenosis/ Occlusion (%)	P value
All cases (n=291)	Yes (184)	24	0.2	11	0.2	35	<0.04
	No (107)	17		7		23
Transluminal angioplasties (n=194)	Yes (112)	25	0.4	19	1.0	29	0.4
	No (82)	4		5		23
Subintimal angioplasties (n=97)	Yes (72)	22	0.4	12	0.4	44	0.1
	No (25)	22		12		24

Reasons for stenting were plaque recoil, dissection or both in 98 cases (53%), 44(24%) and 42(23%), respectively. Six-month patency was 59%, 94% and 69%, respectively. The difference between plaque recoil and dissection was significant (p<0.04).
Conclusion: Stent placement is associated with failure in the femoral-popliteal segment. To our knowledge this is the first report ever to document plaque recoil as a predictor of failure despite stent placement.

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