Ivus As The New Standard For Stent Surveillance
Julia Kleene, MD, Jeffrey C. Hnath, MD, Chin-Chin Yeh, MD, R Clement Darling, III, MD.
Albany Medical College, Albany, NY, USA.
OBJECTIVES: Surveillance protocols for femoral and popliteal artery stents still remain controversial in comparison to their open bypass counterparts. Pulse volume recordings (PVR) and duplex ultrasound (DUS) are commonly used testing modalities, however many recommendations are standards carried over from historical bypass recommendations and one-dimensional angiography. The purpose of this study is to compare IVUS finding for in-stent stenosis to traditional testing modalities as a way to improve stent surveillance. METHODS: 20 consecutive patients with in-stent stenosis, as identified by PVR and DUS during routine surveillance, referred for angiography underwent IVUS evaluation prior to intervention. Data was prospectively collected and compared to the PVR and DUS data using standard statistics to calculate mean and standard deviation using one tailed Students T-test. RESULTS: 20 patients from 10/2017-6/2018, 10 male (50%) with a mean age of 69 (54-91), underwent IVUS prior to intervention. 18 (90%) had HTN, 11 (55%) diabetic, 5 (25%) were current smokers and 20 (100%) were hypertensive. 19 (95%) were on anti-platelet therapy. All 20 were found to have more severe stenosis on IVUS compared to DUS (61.6% vs 82.6%, P<.0005). All in-stent stenosis were treated with combination of debulking with off-label atherectomy devices and balloon angioplasty using drug coated balloons. CONCLUSIONS: Commonly used testing modalities, such as pulse volume recording and duplex ultrasound, may not be adequate when applied to arterial stent surveillance. Preliminary results demonstrate that IVUS is significantly more sensitive for in-stent stenosis and may warrant further large-scale studies as a surveillance modality.
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