Angioscopic Evaluation of Vascular Response After Fluoropolymer-Based Drug-Eluting Stent Implantation for Femoropopliteal Artery Lesions

• Published in: Circulation Journal Vol. 87; no. 3; pp. 432 - 429
• Main Authors: Tsujimura, Takuya, Iida, Osamu, Ishihara, Takayuki, Asai, Mitsutoshi, Masuda, Masaharu, Okamoto, Shin, Nanto, Kiyonori, Matsuda, Yasuhiro, Hata, Yosuke, Uematsu, Hiroyuki, Toyoshima, Taku, Higashino, Naoko, Nakao, Sho, Mano, Toshiaki
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 24.02.2023
• Subjects: Angioscopy; Angioscopy - methods; Coronary Vessels - pathology; Drug-eluting stent; Drug-Eluting Stents; Endovascular therapy; Femoral Artery; Fluorocarbon Polymers; Humans; Neointima - pathology; Peripheral artery disease; Thrombosis - pathology; Treatment Outcome; Peripheral artery disease; Angioscopy; Endovascular therapy; Drug-eluting stent
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-22-0635

Background: Although favorable clinical outcomes have been demonstrated for fluoropolymer-based paclitaxel-eluting stents (FP-DES) in the treatment of femoropopliteal lesions, the vascular response after implantation has not been systematically studied through intravascular imaging.Methods and Results: We angioscopically compared FP-DES: 24 in the early phase (mean [±SD] 3±1 months), 26 in the middle phase (12±3 months), and 20 in the late phase (≥18 months) after implantation. The dominant neointimal coverage grade, heterogeneity of neointimal coverage grade, and thrombus adhesion in the stent segment were evaluated. Neointimal coverage was graded as follows: Grade 0, stent struts exposed; Grade 1, struts bulging into the lumen, although covered; Grade 2, struts embedded in the neointima, but visible; Grade 3, struts fully embedded and invisible. Dominant neointimal coverage and heterogeneity grades were significantly higher in the middle and late phases than in the early phase (all P<0.05), but did not differ significantly between the middle and late phases. The incidence of thrombus adhesion was recorded for all stents in each of the 3 different phases.Conclusions: The middle and late phases after FP-DES implantation were associated with significantly higher dominant neointimal coverage and heterogeneity grades than the early phase. However, thrombus adhesion was observed in all phases after FP-DES implantation. Arterial healing may not be completed even in the late phase after FP-DES implantation.