1652_Soukas.pdf

1、PTAB vs.Covered Stent in ISR:Where do they fit in the algorithm?Peter A.Soukas,MD,FACC,FSVM,FSCAI,FACP,RPVIDirector,Vascular Medicine&Interventional PV LabDirector,Brown Vascular&Endovascular Medicine Fellowship The Miriam&RI Hospitals,Providence,RIAssociate Professor of MedicineBrown Medical School

2、Disclosures Institutional Grant/Research Support:AcoArt,Akura,AngioSafe,AVS,BD,BSC,Cagent Vascular,Cordis,Contego Medical,Endologix,Medtronic,Penumbra,r3Vascular,Reva Medical,Shockwave Medical,W.L.Gore Consultant:Abbott,BSC,Cagent Vascular,Contego Medical,Endologix,Medtronic,Shockwave Medical,W.L.Go

3、re Advisory Board:Abbott,AngioSafe,BSC,Cagent Vascular,Endologix,Medtronic,Shockwave Medical,W.L.GoreISR&Fractures:the Achilles Heel of Stenting!Classification of SFA ISRTosaka ClassificationTosaka,et al.JACC 2012Primary PatencyTosaka,et al.JACC 2012ISR Class Determines Freedom from Recurrent ISR Af

4、ter POBA20%1-Year Primary PatencyClassification of Stent FracturesGray et al.JACC 2016 IN.PACT DCB8.2cm lesion70.5%Viabahn19cm lesion74.8%Treatment of SFA ISR:Randomized TrialsAcoART I:DCB Primary Patency at 2-Yrs:ISR Subgroup RCT of DCB v.PTA Mg-stearate excipient Mean lesion length 14.7 cmGuo,LINC

5、 2017Laser+DCB for ISRSingle center studies of laser+DCB vs.DCB alone in ISRGandini,J Endovasc Ther 2013;20(6):805-14Kokkinidis,CCI 2020;9:439-446RCTDCB for ISR 5-year outcomes:58%fTLRGunnar Tepe et al.J Am Coll Cardiol Intv 2023;16:1065-1078.44.4%required stentingRELINE RCT of Viabahn vs.PTA in SFA

6、 ISRBosiers,J Card Surg 2020;61(5):617-25RELINE:RCT of Viabahn vs.PTA for SFA ISR MC,RCT of VB vs.PTA in ISR,n=83 Mean lesion length:17.3 cm vs.19.0 cm CTO:23%vs.25%Bosiers,J Card Surg 2020;61(5):617-250%25%50%75%100%1 year2 year75%58%28%12%ViabahnPTAPrimary PatencyPatency (%)RELINE:1&2 yr.Freedom f