Predictors for Better Blood-Flow Restoration of Long-Segmental Below-the-Knee Chronic Total Occlusions after Endovascular Therapy in Diabetic Patients

Increased thrombogenicity is associated with revascularization outcomes in patients with chronic limb-threatening ischemia

OBJECTIVES

Clinically driven target lesion revascularization (CD-TLR) frequently occurs after endovascular therapy (EVT) in patients with chronic limb-threatening ischemia (CLTI). The total thrombus-formation analysis system (T-TAS) can quantitatively evaluate thrombogenicity. Therefore, we aimed to elucidate the association of T-TAS parameters with CD-TLR.

METHODS

We analyzed 34 CLTI patients and 62 Non-CLTI patients who underwent EVT. Blood samples collected on the day of EVT were used in T-TAS to compute the thrombus formation area under the curve (PL₂₄-AUC₁₀ in the platelet chip and AR₁₀-AUC₃₀ in the atheroma chip). After the EVT procedure, clinical follow-up was performed, and the presence of CD-TLR was assessed.

RESULTS

During the follow-up period (median 574 days), 10 patients (29%) in the CLTI group and 11 patients (18%) in the Non-CLTI group showed CD-TLR. In the CLTI group, patients who showed CD-TLR had a higher AR₁₀-AUC₃₀ than those who did not (1694 [1657, 1799] vs. 1561 [1412, 1697], p=0.01). In contrast, the PL₂₄-AUC₁₀ showed no significant differences depending on CD-TLR in both groups. For the CLTI patients, multivariable Cox regression analysis using propensity scores revealed that the AR₁₀-AUC₃₀ was an independent predictor of CD-TLR even after adjusting for baseline demographics, lesion characteristics, and anticoagulant use (HR=2.04, 95%CI=1.18-3.88, p=0.01; per 100 increase). In contrast, in Non-CLTI patients, neither the AR₁₀-AUC₃₀ and nor the PL₂₄-AUC₁₀ was significantly associated with CD-TLR. Receiver operating characteristics curve analysis identified an AR₁₀-AUC₃₀ level of 1646 as an optimal cutoff value to predict CD-TLR (AUC = 0.85, sensitivity = 0.93, specificity = 0.56).

CONCLUSIONS

In CLTI patients, but not in Non-CLTI patients, the AR₁₀-AUC₃₀ showed a potential to predict CD-TLR. This finding suggests that hypercoagulability may play a predominant role in the progression of CLTI and anticoagulants may be useful in preventing revascularization.