Cardiovasc Interv Ther. 2026 Mar 3. doi: 10.1007/s12928-026-01255-5. Online ahead of print.
ABSTRACT
In-stent occlusions (ISO) in femoropopliteal lesions increase the risk of repeat occlusion after revascularization for ISO and worsen limb prognosis. This study investigated the impact of dual-pathway inhibitor therapy (DPIT) on clinical outcomes after femoropopliteal ISO revascularization. We retrospectively analyzed 120 limbs in 113 symptomatic patients who underwent EVT for femoropopliteal ISO between August 2012 and October 2021. After ISO revascularization, antithrombotic therapy was switched to DPIT in 39 limbs, whereas dual antiplatelet therapy (DAPT) was continued in 81 limbs. The primary endpoint was repeat ISO. Safety endpoints were major bleeding defined as Bleeding Academic Research Consortium (BARC) grade 3 or 5 bleeding and International Society on Thrombosis and Haemostasis (ISTH) major bleeding. Cox proportional hazards models were used to identify prognostic factors. To adjust for baseline imbalances, inverse probability of treatment weighting (IPTW)-weighted Cox model were performed. One-year freedom from repeat ISO was higher with DPIT than with DAPT (74.7 ± 7.9% vs. 49.1 ± 6.3%; p = 0.029). One-year freedom from BARC 3/5 bleeding (97.4% vs. 97.3%; p = 0.99) and ISTH major bleeding (87.8% vs. 90.2%; p = 0.83) were similar between the two groups. In multivariable analysis, DPIT was associated with lower repeat ISO risk (hazard ratio [HR] 0.41; p = 0.027), whereas chronic limb-threatening ischemia (HR 2.42; p = 0.016) and poor below-the-knee runoff (HR 3.38; p = 0.014) increased risk. In the IPTW-weighted Cox model, DPIT remained associated with reduced repeat ISO (HR 0.39, 95% CI 0.16-0.97; p = 0.043). Switching to DPIT after femoropopliteal ISO revascularization significantly reduced the risk of repeated ISO without increasing major bleeding events.
PMID:41774428 | DOI:10.1007/s12928-026-01255-5