Reintervention Rates for Restenting Versus Angioplasty Alone in Mesenteric Artery In-Stent Restenosis

Mesenteric artery in-stent restenosis (MAISR) is a common complication of endovascular interventions for mesenteric ischemia and the major cause of treatment failure. The objective of this study was to characterize the spectrum of endovascular interventions performed for MAISR at a large academic center and to compare 1-year clinical outcomes between the major treatment groups, angioplasty, and stenting to identify predictors of early reintervention.

Consecutive patients undergoing endovascular intervention for MAISR from 2008 to 2021 in the Cleveland Clinic Health System were identified. Electronic medical records and imaging were reviewed. Univariable and Cox proportional hazard models were used to identify predictors of early reintervention.

Forty-eight patients (54 vessels) required intervention for MAISR. The mean age was 70 years and 36 (66.7%) were female. Angioplasty without stenting was performed in 21 treated vessels (38.8%). Restenting was performed in 33 vessels (61.2%). Median clinical follow-up was 21 months. Restenting had fewer reinterventions over 1 year compared to angioplasty alone [hazard ratio 0.13 (95% confidence interval: 0.03, 0.50), P = 0.003]. No other clinical or operative factors were predictive of reintervention at 12 months in univariable analysis.

Endovascular reintervention for MAISR is associated with a high technical success rate and low perioperative morbidity. Patients who were restented in this cohort were more likely to deny having any symptoms of chronic mesenteric ischemia postintervention, and restenting had fewer reinterventions in the first year compared to angioplasty alone.