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Superficial Femoral Artery Stenting and Acute Thrombosis
There are two major problems after stenting at femoropopliteal arterial system: acute or subacute thrombosis and restenosis derived from either intimal hyperplasia or progressive atherosclerosis. The risk of acute thrombosis was recognized by Rousseau who reported that 25% of patients had thrombosis of the stented SFA segment within the first month after stenting. Thus, many investigators recommend anticoagulation for patients with infrainguinal stents. The early thrombosis rate could be reduced 60% with periprocedural heparin followed by warfarin for several months. In contrast, White et al, using Wallstents and Strecker stents for shrot segment disease without warfarin, noted only two cases with acute thrombosis in 32 patients; it was also noted that acute stent thrombosis occurred more frequently in long lesions. Nowadays interventionists used the antiplatelet agents and then acute thrombosis was reduced below 1%. However, acute thrombosis can be observed despite sufficient antiplatelet therapy. The reason could be a dissection, appearing as a flap immediately adjacent to the proximal end of the stent. If dissections occur, the treatment should be prolonged balloon dilation placement of an additional stent. Even in the procedure, acute thrombosis was rarely observed within stent site or at proximal or distal edge of balloon or stent site which was damaged by balloon. Intraprocedural acute thrombosis was a dangerous situation and operators should catch early to manage the thrombosis. Intraoperative acute thrombosis was able to be treated with mechanical thrombectomy catheters such as the Export Catheter or Rheolytic Catheters such as the Angiojet. Operators can also choose to deliver lytics locally through an infusion catheter for a few minutes or overnight. Laser is also another option in these patients.
REFERENCES
1. Rousseau HP, Raillat CR, Joffre FG, Knight CJ, Ginestet MC. Treatment of femoropopliteal stenoses by means of self-expandible endoprotstheses: midterm results. Radiology 1989;172:961-4.
2. White GH, Liew SC, Waugh RC, et al. Early outcome and intermediate follow-up of vascular stems in the femoral and popliteal arteries without long-term anticoagulation. J Vasc Surg 1995;21:270-81.
3.Strecker EP, Gottmann D, Boos IB, Vetter S. Low-molecular-weight hepain (reviparin) reduces the incidence of femoropopliteal in-stent stenosis: preliminary results of an ongoing study. Cardiovasc Intervent Radiol 1998;21:375-9.

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