Long In-Stent Restenosis of the Superficial Femoral Artery Successfully Treated Using OCT-Guided Directional Atherectomy
Golzar, et. al. Vascular Disease Management 2017;14(8);E174-E177
The treatment and management of patients with in-stent restenosis (ISR) remains an important clinical challenge. ISR cases involving the superficial femoral and popliteal arteries are complex due to the potential for multivariable complications, including severe neointimal proliferation, stent fracture, and increased restenosis lesion length. We present a challenging superficial femoral artery ISR chronic total occlusion in a 66-year-old female with a history of severe vascular disease. She presented with rest pain and computed tomography angiographic evidence of moderate calcification surrounding a re-occluded drug-eluting stent. The ISR disease morphology and distribution were visualized and removed using optical coherence tomography (OCT)-guided directional atherectomy. Avinger’s Pantheris catheter is the first therapeutic device to incorporate real-time OCT for intravascular imaging. OCT provides visualization without the need for contrast or x-ray radiation. This case demonstrates the successful recanalization of a complex superficial femoral artery ISR chronic total occlusion utilizing the Pantheris catheter.
Keywords: peripheral arterial disease, chronic total occlusion, in-stent restenosis, peripheral intervention, optical coherence tomography