Angioscopy-Guided Excimer Laser Atherectomy in Femoropopliteal In-Stent Occlusions.

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Endovascular Therapy

Background:

• In-stent occlusions in femoropopliteal lesions (FP-ISOs) are a significant clinical challenge.
• These lesions often comprise thrombi and neointimal hyperplasia.
• Excimer laser atherectomy (ELA) can ablate tissue, including thrombi, making it a potential treatment modality.

Purpose of the Study:

• To investigate the utility of angioscopy-guided Excimer Laser Atherectomy (ELA) for treating femoropopliteal in-stent occlusions (FP-ISOs).
• To compare outcomes based on thrombus burden in patients undergoing ELA for FP-ISOs.

Main Methods:

• A study of 10 consecutive patients with FP-ISO treated with ELA between August 2020 and May 2023.
• Patients were categorized into two groups based on preprocedural angioscopy: M (thrombi <70%) and S (thrombi ≥70%).
• Outcomes including Thrombolysis in Myocardial Infarction (TIMI) flow grade and major adverse events (MAE) were assessed.

Main Results:

• No significant differences in immediate post-procedure TIMI grade 3 flow or 1-month ankle-brachial pressure index between groups.
• Similar clinical outcomes at 6 months, with patency rates of 60% (M) vs. 80% (S) and MAE rates of 40% (M) vs. 60% (S).
• Five patients on direct oral anticoagulants (DOACs) experienced no adverse events.

Conclusions:

• ELA effectively vaporizes thrombi in FP-ISOs, yielding comparable outcomes irrespective of initial thrombus burden.
• Angioscopy-guided ELA, particularly when combined with DOAC therapy, presents a viable strategy for managing FP-ISOs.