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Home > Vascular Annual Meeting^® > RR26. Natural History of Mesenteric Artery Stent...

RR26. Natural History of Mesenteric Artery Stent Restenoses and Clinical and Anatomic Predictors for Re-intervention in Patients with Chronic Mesenteric Ischemia

Gustavo S. Oderich, Thanila A. Macedo, Rafael Malgor, Joseph J. Ricotta, II, Terri Vrtiska, Audra A. Duncan, Manju Kalra, Peter Gloviczki
Mayo Clinic, Rochester, MN

OBJECTIVES: To determine the natural history, clinical and anatomical predictors of mesenteric artery stent (MAS) restenosis in patients with chronic mesenteric ischemia (CMI).

METHODS: The clinical data of 102 patients treated with 127 MAS for CMI was entered into a prospective database (2001-2006). Data was reviewed in 87 patients (57 female, 30 male; median age 77 years) with imaging follow up >3 months (mean 28±22 months). Pre-procedure computed tomography angiography (CTA) with centerline of flow analysis and biplanar angiography were reviewed to determine anatomic measurements. Mesenteric restenosis was defined as >60% restenosis by CTA, angiography or duplex ultrasound. Univariate and logistic regression analysis was performed to identify factors associated with restenosis.

RESULTS: There were 71 SMA and 35 celiac stents. Forty-seven patients (54%) developed restenosis. Symptomatic restenoses in 17 patients (13 chronic, 4 acute) were treated with re-intervention (12 endovascular, 3 open) in all except 2 patients who died of unrelated causes. Asymptomatic restenoses in 30 patients (23 with angiographic confirmation) were followed for 30±25 months: 4 (13%) developed symptoms (3 chronic, 1 acute) and 8 had re-interventions (4 prophylactic). There were no deaths associated with re-interventions and 82 patients (94%) referred symptom improvement at their last visit. Freedom from restenosis, recurrence and re-intervention at 3-years was 35±6%, 65±7% and 65±7%. Primary and secondary patency rates were 60±7% and 86±5% at same intervals. There were more (p<.05) restenoses in female patients (63% vs. 37%), and those with occlusions (100% vs. 46%), severe calcification (80% vs 40%), longer lesions (>30mm, 71% vs. 52%) and vessel diameter <7 mm (63% vs. 21%). Occlusions and severe calcification were independently associated with higher risk of restenosis (p<.01).

CONCLUSIONS: MAS restenoses occur in approximately half of the patients, of which half develop recurrent mesenteric ischemia. Our results support a conservative approach for asymptomatic restenosis and a policy of early re-intervention in the presence of symptoms. Patients with longer or calcified lesions and those with residual post-procedure stenosis have the highest re-intervention rates.

AUTHOR DISCLOSURES: G.S. Oderich, Cook Medical and WL Gore; T.A. Macedo, None; R. Malgor, None; J.J. Ricotta, None; T. Vrtiska, None; A.A. Duncan, None; M. Kalra, None; P. Gloviczki, None.