Impact of procedural techniques on mid-term patency of fluoropolymer-based drug-eluting stent placed in the femoropopliteal artery.

PURPOSE: To investigate the impact of optimal procedural techniques on the mid-term patency of fluoropolymer-based drug-eluting stent (FP-DES) in femoropopliteal artery.

METHODS AND METHODS: This retrospective study included 200 femoropopliteal lesions (chronic limb-threatening ischemia, 59%; chronic total occlusion, 41%) in 173 patients (male, 66%; diabetes mellitus, 62%; hemodialysis, 40%) with lower extremity arterial disease undergoing intravascular ultrasound (IVUS)-guided endovascular therapy with FP-DES between January 2016 and July 2021. The primary outcome measure was restenosis, defined as a peak systolic velocity ratio of >2.4 based on the DUS findings. The association between procedural techniques and the incidence of restenosis was investigated using Cox proportional hazards regression models.

RESULTS: The 2-year cumulative incidence of restenosis was 19.5±3.3%. Multivariate analysis revealed that non-compliance with procedural techniques, such as plaque burden at the stent edge <50%, MSA >12 mm2 , and stent placement within the P1 segment, were independently associated with an increased risk of restenosis (hazard ratios [HRs], 3.22, 4.71, and 4.67; p=0.004, p<0.001, and p<0.001, respectively). The 2-year restenosis risk was 8.4±3.4% for those in compliance with all 3-technical criteria, while the risk for those in compliance with 2-technical criteria or 0 or 1 technical criteria was 25.0±6.2% and 48.6±10.4%, respectively. The HR relative to 3-technical criteria compliance was 3.79 (p=0.007) and 11.85 (p<0.001), respectively.

CONCLUSION: Non-compliance with procedural techniques, including plaque burden at stent edge <50%, MSA >12 mm2 , and stent placement within the P1 segment, was significantly associated with an increased risk of 2-year restenosis after FP-DES implantation in femoropopliteal artery.