1622_Mouawad.pdf

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1、Therapy of Choice for In-Stent RestenosisNicolas J.Mouawad,MD MPH MBA DFSVS FACS FRCS RPVIChief,Vascular&Endovascular SurgeryChair,Department of SurgeryChair,Cardiovascular ResearchMcLaren Health System,Bay City,MI USANickMouawadMDDisclosures Advisory Board:Boston Scientific,Contego Medical,Inari Me

2、dical,Veryan Medical CEC:Magical BTK,ELITE R3 BTK Consultant:Bard BD,Boston Scientific,Contego Medical,Endologix LLC,Inari Medical,Microvention,MiMedx,Philips,Silkroad Medical,Shockwave Medical,Terumo,WL Gore Proctor:Endologix LLC,Inari Medical,Silkroad Medical,Terumo Aortic Speaker:Abbott/CSI,Janss

3、en Pharmaceuticals,Medtronic PeripheralIn-Stent Restenosis Vessel injury due to angioplasty,atherectomy,or stent struts causing endothelial dysfunction Platelet activation,inflammatory cells proliferation of vascular smooth muscle cells and extracellular matrix Zain,M,et al,Neointimal Hyperplasia,St

4、atPerals,2022Moser,J,et al,Differences in Neointimal Hyperplasia with Femoral Artery Injury,Nature 2015Michael Lichtenberg,MD,EVT 2016ISR Rates after Femoropopliteal Stenting 68.384.372.268.281.392.378.991.695.5FAST(Luminexx)1FESTO(Smart,SelfX,Luminexx)2DURABILITY I(Protg)3DURABILITY200(ProtgLL)4RES

5、ILIENT(LifeStent)5SIROCCO II(SMART)6SUPERB(Supera)7Zilver PTX 8IMPERIAL(Eluvia)9Freedom from TLR at 12 Months(%)1 Krankenberg,H,et al,Circ 20072 Vroegindeweij,D,et al,Cardiovasc Inter Rad,19973 Bosier,M,et al,JEVT 20094 Bosier,M,et al,JVS 20115 Laird,JR,et al,Circ Cardiovasc Inter 20106 Duda,SH,et a

6、l,J Vasc Inter Rad 20057 Garica,L.,et al,Circ Cardiovasc Inter 20158 Dake MD,et al,Circ Cardiovasc Inter 20119 Gray,W,et al,Lancet 2018STUDIES SUGGEST THAT 5-30%OF STENTS REQUIRE REINTERVENTION AT 1 YEARDrug Coated Balloon Angioplasty 119 patients ISR(50%)and CLI RCT DCB(n=62)or POBA(n=57)Mean lesio