PMC7383611_01
Panels (a) and (b) show baseline and final angiography at the index procedure in September 2014. Panels (c) and (d) show baseline and final angiography at the fourth procedure in May 2016. A white arrow indicates the segments where Zilver PTX 6.0-120 mm stent was deployed at this time.
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Angiography revealed occlusion of femoropopliteal bypass graft (Figure 1(a)). We deployed three MISAGO 6.0-100 mm stents (Terumo, Japan) and an optimal angiography was obtained (Figure 1(b)). Endovascular therapy was started by left femoral approach and baseline angiography showed total occlusion form proximal SFA to the middle of most distally implanted MISAGO stent (Figure 1(c)). The procedure ended with Zilver PTX 6.0-120 mm stent (Cook Medical, United States) deployment followed by post-ballooning (SABER 6.0-150 mm balloon (Cordis)) at distal lesion where recurrent in-stent restenosis occurred (Figure 1(d)).
Panel (a) shows angiography in March 2020. Panels (b) and (c) show angioscopic findings at MISAGO stent (a black arrow) that was deployed 6 years before and Zilver PTX stent (a white arrow) that was deployed 4 years before.
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After that procedure, medication of edoxaban 15 mg, clopidogrel 75 mg, and cilostazol 200 mg continued without any bleeding complications and angiography showed patent SFA in March 2020 (Figure 2(a)). In angioscopy findings in March 2020, MISAGO stent struts were invisible (Figure 2(b)); however, entire Zilver PTX stent struts were embedded in the neo-intima and still translucent (Figure 2(c)).