Abstract
IntroductionHypolysible fibrin clots composed of tightly packed fibers characterize patients with peripheral artery disease (PAD) especially those with critical limb ischemia (CLI). Little is known about the impact of a prothrombotic clot phenotype on restenosis following endovascular revascularization in CLI. The goal of this study was to compare fibrin clot properties and their determinants in CLI patients with restenosis after endovascular treatment (ET) and those free of this complication.Methods85 patients with CLI and restenosis within 1 year after ET on optimal pharmacotherapy and 47 PAD control patients without restenosis were included into the study. Plasma fibrin clot permeability (Ks, a measure of the average pore size in the fibrin network) and clot lysis time (CLT) with its potential determinants were determined. During follow-up, the composite endpoint including re-intervention, amputation and death was assessed.ResultsCompared with the control group, patients with restenosis had reduced Ks (− 9.5%, p < 0.001), prolonged CLT (+ 12.4%, p = 0.003), higher thrombin generation (+ 7.9%, p < 0.001) and elevated von Willebrand factor (vWF) antigen (+ 14.2%, p < 0.001). During a 24 months follow-up the composite endpoint occurred in 54 CLI patients with restenosis (63.5%) and nine control patients (19.1%, p < 0.001) with no association with baseline Ks and CLT.ConclusionThe increased thrombin formation and unfavorable fibrin clot properties occur in patients with CLI who experienced restenosis despite optimal endovascular and pharmacological therapy.
Highlights
Hypolysible fibrin clots composed of tightly packed fibers characterize patients with peripheral artery disease (PAD) especially those with critical limb ischemia (CLI)
We hypothesized that PAD patients with CLI who experienced restenosis despite optimal endovascular and pharmacological treatment characterize more prothrombotic fibrin clot properties involving denser fiber meshwork relatively resistant to lysis compared with those with good outcomes at a 1 year follow-up
The mean time of restenosis occurrence was 21 weeks (3–50 weeks) and the re-intervention time in most patients (62.4%) was 2–3 weeks longer (p = 0.19). 32 patients (37.6%) required immediate intervention. Both ABI and toe-brachial index (TBI) were lower in the restenosis group
Summary
Hypolysible fibrin clots composed of tightly packed fibers characterize patients with peripheral artery disease (PAD) especially those with critical limb ischemia (CLI). Methods 85 patients with CLI and restenosis within 1 year after ET on optimal pharmacotherapy and 47 PAD control patients without restenosis were included into the study. During a 24 months follow-up the composite endpoint occurred in 54 CLI patients with restenosis (63.5%) and nine control patients (19.1%, p < 0.001) with no association with baseline Ks and CLT. Conclusion The increased thrombin formation and unfavorable fibrin clot properties occur in patients with CLI who experienced restenosis despite optimal endovascular and pharmacological therapy. We hypothesized that PAD patients with CLI who experienced restenosis despite optimal endovascular and pharmacological treatment characterize more prothrombotic fibrin clot properties involving denser fiber meshwork relatively resistant to lysis compared with those with good outcomes at a 1 year follow-up. The 1 year incidence of major amputations (above the ankle), as well as MI or stroke in patients with CLI without revascularization reaches 30–50% and death occurs in up to 25% in the five following years [1, 6]
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