A Promising New Tool for Managing Recurrent In Stent Restenosis in Full Metal Jackets

Louisiana has historically had the highest amputation rate in the country, followed secondly by other nearby states in the southern US. Years of heavy peripheral vascular stenting to prevent amputations in these patients has lead to referrals of patients with FMJ/Full Metal Jackets. Recurrent procedures in these patients lead to poor outcomes and repeat admissions. We suggest using regular drug coated balloons in these patints with recurrent ISR of full metal jackets. I present one of these patients with excellent results since we used drug coated balloons in her stent jacket.

64-year-old vasculopath female with a history of HTN,HLD,PAD s/p failed bypass grafting and multiple PVI (42 LE angiogram with 32 PVI/stent placements) who presented with her ninth critical limb ischemia admit. Her ABI showed a significant decrease over past month in Left from 0.8 to 0.2 and on right from 0.8 to 0.3. Left peripheral angiogram showed left EIA/CFA & SFA stents were totally occluded with reconstitution of flow BTK in the popliteal artery while proximal popliteal stent had 90% ISR. AT had 80 % ostial stenosis. Peroneal were occluded in the proximal segment and reconstituted distally. Right lower extremity peripheral angiogram showed right EIA had severe (80 % stenosis) while Right CFA had severe ISR. SFA proximal had severe ISR . Given the heavy Stent load and recurrent ISR, we decided to use DCB throughout the ISR in her stent jacket. PVI was done using paclitaxel DCB in right AT, Pop, SFA, CFA and left CFA, EIA & SFA . She had excellent results angiographically. Her ABI improved to 0.9 bilaterally in 2 week follow up with resolution of claudication. Patient did not have any repeat admission or procedure for next 10 months- this being the longest disease free period for her in past 9 years.