Histopathological evidence of adventitial or medial injury is a strong predictor of restenosis during directional atherectomy for peripheral artery disease

Arthur Tarricone, Ziad Ali, Anitha Rajamanickam, Karthik Gujja, Vishal Kapur, K. Raman Purushothaman, Meerarani Purushothaman, Miguel Vasquez, Adrian Zalewski, Micheal Parides, Jessica Overbey, Jose Wiley, Prakash Krishnan

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

Purpose: To investigate the impact on restenosis rates of deep injury to the adventitial layer during directional atherectomy. Methods: Between 2007 and 2010, 116 consecutive patients (mean age 69.6 years; 56 men) with symptomatic femoropopliteal stenoses were treated with directional atherectomy at a single center. All patients had claudication and TASC A/B lesions in the superficial femoral or popliteal arteries. Histopathology analysis of atherectomy specimens was performed to identify adventitial injury. Clinical follow-up included physical examination and duplex ultrasound scans at 3, 6, and 12 months in all patients. The primary endpoint was the duplex-documented 1-year rate of restenosis, which was determined by a peak systolic velocity ratio <2.4. Patients were dichotomized by the presence or absence of adventitial or medial cuts as evaluated by histopathology. Results: Adventitial injury were identified in 62 (53%) of patients. There were no differences in baseline demographic and clinical features (p>0.05), lesion length (58.7±12.8 vs 56.2±13.6 mm, p=0.40), or vessel runoff (1.9±0.6 vs 2.0±0.6, p=0.37) between patients with and without adventitial injury, respectively. The overall 1-year incidence of restenosis was 57%, but the rate was significantly higher (p<0.0001) in patients with adventitial or medial injury (97%, 60/62) as compared with those without (11%, 6/54). Conclusion: Lack of adventitial injury after atherectomy for femoropopliteal stenosis is strongly related to patency at 1 year.

Original languageEnglish (US)
Pages (from-to)712-715
Number of pages4
JournalJournal of Endovascular Therapy
Volume22
Issue number5
DOIs
StatePublished - Oct 1 2015
Externally publishedYes

Keywords

  • Adventitia
  • Atherectomy
  • Media layer
  • Peripheral artery disease
  • Plaque
  • Restenosis
  • Vessel injury

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Tarricone, A., Ali, Z., Rajamanickam, A., Gujja, K., Kapur, V., Purushothaman, K. R., Purushothaman, M., Vasquez, M., Zalewski, A., Parides, M., Overbey, J., Wiley, J., & Krishnan, P. (2015). Histopathological evidence of adventitial or medial injury is a strong predictor of restenosis during directional atherectomy for peripheral artery disease. Journal of Endovascular Therapy, 22(5), 712-715. https://doi.org/10.1177/1526602815597683