4.6 Article

Clinical Impact of Intravascular Ultrasound-Guided Fluoropolymer-Based Drug-Eluting Stent Implantation for Femoropopliteal Lesions

Journal

JACC-CARDIOVASCULAR INTERVENTIONS
Volume 15, Issue 15, Pages 1569-1578

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.jcin.2022.06.012

Keywords

drug-eluting stent(s); endovascular therapy; femoropopliteal lesions; intravascular ultrasound; peripheral artery disease

Funding

  1. Research Association for Lower Limb Artery Revascularization (LIBERAL)
  2. Boston Scientific Japan K. K.
  3. OrbusNeich Foundation
  4. Terumo Corp.
  5. Kaneka Medix Corporation
  6. Edwards Lifesciences
  7. FUJIFILM RI Pharma
  8. REGiMMUNE
  9. Roche Diagnostics
  10. Otsuka Pharmaceutical
  11. Johnson Johnson
  12. St. Jude Medical Japan
  13. Daiichi Sankyo
  14. Takeda Pharmaceutical
  15. Mitsubishi Tanabe Pharma
  16. Teijin Pharma Limited
  17. Boehringer Ingelheim Japan
  18. Bayer Yakuhin
  19. BIOTRONIK Japan
  20. Boston Scientific
  21. Medtronic Japan
  22. Abbott Vascular Japan

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This study investigated the impact of IVUS on 1-year clinical outcomes after FP-DES implantation in patients with symptomatic peripheral artery disease. The study found that there was no significant difference in 1-year restenosis risk between the IVUS group and the non-IVUS group, but the incidence of aneurysmal degeneration was significantly higher in the IVUS group.
BACKGROUND Treatment with a fluoropolymer-based drug-eluting stent (FP-DES has been widely applied to the contemporary femoropopliteal practice with durable outcomes. Nevertheless, the impact of intravascular ultrasound (IVUS) utilization on clinical outcomes after FP-DES implantation has not been determined. OBJECTIVES This study aimed to investigate the impact of IVUS on 1-year clinical outcomes after FP-DES) implantation for femoropopliteal lesions in patients with symptomatic peripheral artery disease. METHODS As a subanalysis of the CAPSICUM (contemporary outcomes after paclitaxel-eluting peripheral stent implantation for symptomatic lower limb ischemia with superficial femoral or proximal popliteal lesion) study, the present investigation analyzed 1,091 patients with symptomatic peripheral artery disease who underwent endovascular therapy with FP-DES for femoropopliteal lesions. One-year clinical outcomes were compared between patients treated with IVUS and those treated without IVUS after propensity score matching. The primary outcome measure was 1-year restenosis. The incidence of aneurysmal degeneration was also assessed. RESULTS A total of 843 (77.2%) patients underwent IVUS-guided FP-DES implantation. After propensity score matching, the 1-year restenosis was not significantly different between the groups (11.5% [95% CI: 9.1%-14.0%] vs 15.5% [95% CI: 10.9%-20.1%]; P = 0.22). The frequency of aneurysmal degeneration at 1 year was significantly higher in the IVUS group than in the non-IVUS group (19.8% [95% CI: 16.3%-23.4%] vs 7.1% [95% CI: 3.3%-11.0%]; P < 0.001). IVUS use was associated with a lower restenosis risk in patients with chronic total occlusion but not in those without (P for interaction = 0.044). CONCLUSIONS The present study revealed that 1-year restenosis risk was not significantly different between the 2 groups, whereas the incidence of aneurysmal degeneration was significantly higher in the IVUS group. (C) 2022 by the American College of Cardiology Foundation.

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