Study Supports Laser Atherectomy With Balloon Angioplasty to Treat Femoropopliteal ISR

August 28, 2015—Laser atherectomy with adjunctive balloon angioplasty may be associated with improved patency when used to treat complex femoropopliteal in-stent restenosis (ISR), including in-stent occlusions, concluded Ehrin J. Armstrong, MD, et al in a study published in the Journal of Endovascular Therapy (JEVT, 2015;22:506–513).

As summarized in JEVT, this dual-center study was composed of 135 symptomatic patients (mean age, 71 years; 76 men) who underwent endovascular treatment of femoropopliteal ISR between 2006 and 2013. Of these patients, 54 (40%) were treated with laser atherectomy and the remaining 81 patients were treated with balloon angioplasty alone.

Angiographic images were reviewed for lesion morphology and characteristics, TransAtlantic InterSociety Consensus TASC 2 classification, and distal runoff. Class 1 ISR was defined as focal lesions ≤ 50 mm, class 2 ISR was defined as lesions > 50 mm, and class 3 ISR was defined as stent total occlusion. Recurrent ISR was determined by a peak systolic velocity ratio > 2.4 by duplex ultrasound. 

The investigators noted that patients treated with laser atherectomy had longer mean ISR lesion length (222 mm vs 114 mm) and more class 3 ISR (69% vs 20%). There was no association between laser atherectomy and rates of recurrent restenosis, or occlusion for patients with class 1or 2 ISR, but there was a significantly lower rate of target lesion revascularization at 2 years among patients treated with laser atherectomy (14% vs 44%). 

By comparison, patients with class 3 ISR treated with laser atherectomy had lower rates of recurrent restenosis at 1 year (54% vs 91%) and 2 years (69% vs 100%). Patients with class 3 ISR treated with laser atherectomy also had lower rates of recurrent in-stent occlusion at 2-year follow-up (33% vs 71%).