Restenosis of Endovascular Stents From Stent Compression

• Published in: Journal of the American College of Cardiology Vol. 29; no. 2; pp. 328 - 338
• Main Authors: Rosenfield, Kenneth, Schainfeld, Robert, Pieczek, Ann, Haley, Laura, Isner, Jeffrey M
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.1997; Elsevier Science
• Subjects: Aged; Biological and medical sciences; Catheterization; Constriction, Pathologic; Coronary Angiography; Diseases of the cardiovascular system; Female; Femoral Artery - pathology; Fluoroscopy; Humans; Male; Medical sciences; Middle Aged; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Renal Dialysis; Stents; Ultrasonography, Interventional; Vascular Patency; CSA; ABI; IVUS; FAST; PTA; SFA; Sonography; Superficial femoral artery; Human; Endoprosthesis; Compression; Instrumentation therapy; Exploration; Endovascular route; Instrumental dilatation; Surgical arteriovenous anastomosis; Restenosis; Treatment; Echography; Complication
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(96)00498-6

Objectives. We sought to determine the basis for restenosis within superficial femoral arteries (SFAs) and hemodialysis conduits treated with balloon-expandable stents. Background. Use of stents within coronary and peripheral vessels continues to increase exponentially. The mechanism of restenosis within stents placed at various vascular sites is not well understood. In particular, the implications of deploying a balloon-expandable stent in a compressible site are not well understood. Methods. After the serendipitous detection of stent deformation during intravascular ultrasound (IVUS) examination of a restenosed dialysis fistula, we evaluated a consecutive series of patients with stents placed in compressible vascular sites, including the SFA (six patients) and hemodialysis fistulae (five patients). Clinical, angiographic and IVUS examinations were performed to evaluate mechanisms of restenosis. Results. Stent compression was identified as the principal cause of restenosis in all dialysis conduits and SFAs. Stent deformity was not reliably identified by angiography; however, IVUS identified compression of two forms: eccentric deformation, implicating two-point compressive force, and complete circumferential encroachment of stent struts around the catheter, suggesting multidirectional compressive force. Despite redilation, secondary restenosis resulting from recurrent compression recurred in most sites. Conclusions. Restenosis within balloon-expandable endovascular stents may occur as a result of stent compression, a phenomenon readily detected by IVUS, but often not by angiography. These findings have significant implications for the use of balloon-expandable stents within vascular sites subject to extrinsic compression, such as hemodialysis conduits, the adductor canal segment of the SFA and carotid arteries. (J Am Coll Cardiol 1997;29:328–38)