Print this pagePredictive 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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