Stent Graft Restenosis: Insights From Optical Coherence Tomography Imaging and Treatment Considerations

Endovascular therapy (EVT) utilizing self-expanding stent grafts has shown promising clinical outcomes for femoropopliteal lesions. However, restenosis and thrombotic occlusion remain significant concerns with unclear underlying mechanisms. This is the case of a 53-year-old male with diabetic nephropathy requiring hemodialysis. He presented with left lower limb intermittent claudication and underwent EVT, resulting in subsequent restenosis 12 months post-implantation and recurrence of symptoms. Intravascular imaging revealed neointimal proliferation and stent-edge restenosis, with segments of neointima not in contact with the stent. A second EVT procedure was performed successfully with the endograft extension. Our case highlights the challenges in diagnosing and managing stent graft restenosis. Intravascular imaging modalities such as optical coherence tomography (OCT) were crucial in identifying the etiology and guiding treatment decisions. The presence of neointima not in contact with the stent suggests a potential mechanism for thrombus formation and underscores the importance of tailored treatment strategies. This case underscores the utility of OCT in evaluating stent graft restenosis and guiding therapeutic interventions. Further research is warranted to elucidate optimal treatment strategies for this challenging complication.