Clinical impact of self-expandable stent diameter after femoropopliteal stenting

The optimal diameter of a self-expandable stent for femoropopliteal (FP) artery disease remains unclear. The aim of this study is to investigate the influence of stent diameter on the clinical outcome after FP stenting and to identify optimal stent diameter of self-expandable stent implantation. This study was a prospective observational study. Eighty patients who underwent successful self-expandable stent implantation for FP disease were enrolled in this study. A commercially available self-expandable stent was used. The operator determined the type, diameter and length of the stent based on a visual estimate in angiography. A peak systolic velocity ratio >2.0 was defined as restenosis. Primary patency was defined as treated vessel without restenosis and repeat revascularization. Secondary patency was defined as target vessel which subsequently become totally occluded and is reopened by repeat revascularization. As a result, restenosis was found in 34 patients (42.5%) during the follow-up of 24 months. In-stent restenosis was independently predicted by stent fracture [hazard ratio (HR) 2.6, p = 0.01], chronic total occlusion (HR 2.4, p = 0.02) and stent diameter ×10/vessel diameter (S/V) ratio (HR 1.7, p = 0.04). Using receiver-operator characteristic analysis, S/V ratio >1.30 best separated patients with and without in-stent restenosis. Primary and secondary patency was significantly lower in patients with S/V ratio >1.30 (85 vs. 44%, p = 0.002 and 90 vs. 65%, p = 0.009, respectively). In conclusion, an S/V ratio was an independent predictor of in-stent restenosis after FP stenting, and it was also associated with the clinical outcome. © 2010 Japanese Association of Cardiovascular Intervention and Therapeutics.