Preliminary experience with cutting balloon angioplasty for iliac artery in-stent restenosis

Purpose: To report our preliminary experience using cutting balloon angioplasty (CBA) in symptomatic iliac artery in-stent restenosis (ISR). Methods: Fourteen cases of hemodynamically significant iliac artery ISR (4 common and 10 external) were treated in 12 men (mean age 64 years, range 55-75). Of the 14 stents involved, 8 were balloon-expandable models and 6 were self-expanding. All patients had symptomatic deterioration of at least 1 clinical category over an average period of 50.2 months (range 6-120) post stenting. The mean length of ISR was 11.9 mm (range 2-48), and the average stenosis was 75.4% (range 52%-98%). Nine ISR lesions were focal (<10 mm), 4 were diffuse (>10 mm), and 1 extended outside the stent margins. Results: CBA was performed after conventional angioplasty failure in 7 lesions and as a primary treatment method in 7 lesions. Single (9 focal lesions) or multiple overlapping (5 diffuse or proliferative lesions) inflations were performed using 6- x 10-mm (1 lesion), 7- x 10-mm (3 lesions), and 8- x 10-mm (10 lesions) devices. There was 1 contained rupture treated with a covered stent. In the remainder of the cases, the cutting balloons allowed successful treatment without further stent implantation. During a mean follow-up of 23.6 months (range 12-60), no patient showed clinical deterioration, and no recurrent ISR was detected with color duplex. Conclusion: CBA shows high immediate technical and midterm clinical success in symptomatic iliac artery ISR.