Subhash Banerjee

Background. There is limited “real-world” evidence examining treatment modalities and outcomes in patients with symptomatic peripheral arterial disease undergoing endovascular treatment of femoropopliteal (FP) in-stent restenosis (ISR). Materials and Methods. We compared outcomes in 2,895 patients from the XLPAD registry (NCT01904851) between 2006 and 2019 treated for FP ISR (n = 347) and non-ISR (n = 2,548) lesions. Primary endpoint included major adverse limb events (MALE) at 1 year, a composite of all-cause death, target limb repeat revascularization, or major amputation. Results. ISR patients were more frequently on antiplatelet (94.5% vs 89.4%, p = 0.007 ) and statin (68.9% vs 60.3%, p = 0.003 ) therapies. Lesion length was similar (ISR: 145 ± 99 mm vs. non-ISR: 142 ± 99 mm, p = 0.55 ). Fewer treated ISR lesions were chronic total occlusions (47.3% vs. 53.7%, p = 0.02 ) and severely calcified (22.4% vs. 44.7%, p < 0.001 ). Atherectomy (63.5% vs. 45.0%, p < 0.001 ) and drug-coated balloons (DCB; 4.7% vs. 1.7%, p < 0.001 ) were more frequently used in ISR lesions. The distal embolization rate was higher in ISR lesions (2.4% vs. 0.9%, p = 0.02 ). Repeat revascularization (21.5% vs. 16.7%, p = 0.04 ; Figure) was higher and freedom from MALE at 1 year was significantly lower (87% vs. 92.5%, p < 0.001