Preoperative Sizing to Lower In-Stent Restenosis in Peripheral Arterial Occlusive Disease

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Medical Imaging

Background:

• Peripheral arterial occlusive disease (PAOD) is commonly treated with angioplasty stenting.
• In-stent restenosis is a primary complication, often linked to improper stent sizing.
• Preoperative sizing aims to improve stent selection and reduce restenosis.

Purpose of the Study:

• To evaluate if using sizing software for stent selection reduces in-stent restenosis in PAOD patients.
• To assess the benefits of routine preoperative stent sizing.

Main Methods:

• A study included patients treated for PAOD with angioplasty stenting from 2016-2020.
• Preoperative computed tomography angiography and sizing software determined IDEAL stent dimensions.
• IDEAL stents were compared against ACTUAL stents (intraoperatively chosen) for 1-year in-stent restenosis rates.

Main Results:

• No significant difference in 1-year restenosis rates between IDEAL (13%) and ACTUAL (17%) stent groups.
• A subgroup analysis of ACTUAL stents revealed a significantly higher restenosis rate (19.6%) when diameter mismatch occurred.
• Diameter discordance in stent selection was linked to increased restenosis.

Conclusions:

• Preoperative sizing using software did not significantly lower 1-year in-stent restenosis rates.
• Accurate stent diameter selection is crucial for preventing early in-stent restenosis.
• Oversized or undersized stents, particularly those not selected via precise sizing, lead to higher restenosis rates.