PMID- 35390483 OWN - NLM STAT- MEDLINE DCOM- 20220726 LR - 20220814 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 76 IP - 2 DP - 2022 Aug TI - Increased thrombogenicity is associated with revascularization outcomes in patients with chronic limb-threatening ischemia. PG - 513-522.e3 LID - S0741-5214(22)01368-4 [pii] LID - 10.1016/j.jvs.2022.03.874 [doi] AB - 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 the T-TAS parameters with CD-TLR. METHODS: We analyzed 34 patients with CLTI and 62 patients without CLTI who had undergone EVT. Blood samples collected on the day of EVT were used in the T-TAS to compute the thrombus formation area under the curve for the first 10 minutes for the platelet chip tested at a flow rate of 24 muL/min (PL(24)-AUC(10)) and area under the curve for the first 30 minutes for the atheroma chip tested at a flow rate of 10 muL/min (AR(10)-AUC(30)). After EVT, 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 (18%) in the non-CLTI group had required CD-TLR. In the CLTI group, the patients with CD-TLR had had a higher AR(10)-AUC(30) vs those without (median, 1694 [interquartile range, 1657-1799] vs median, 1561 [interquartile range, 1412-1697]; P = .01). In contrast, the PL(24)-AUC(10) showed no significant differences when stratified by CD-TLR in either group. For the CLTI patients, multivariable Cox regression analysis using propensity score matching revealed that the AR(10)-AUC(30) was an independent predictor of CD-TLR even after adjusting for baseline demographics, lesion characteristics, and anticoagulant use (hazard ratio, 2.04; 95% confidence interval, 1.18-3.88; P = .01; per 100-unit increase). In contrast, for those without CLTI, neither the AR(10)-AUC(30) nor the PL(24)-AUC(10) was significantly associated with CD-TLR. Receiver operating characteristics curve analysis identified an AR(10)-AUC(30) level of 1646 as an optimal cutoff value to predict for CD-TLR (AUC, 0.85; sensitivity, 0.93; specificity, 0.56). CONCLUSIONS: For patients with CLTI, but not for those without CLTI, the AR(10)-AUC(30) showed potential to predict for CD-TLR. This finding suggests that hypercoagulability might play a predominant role in the progression of CLTI and that anticoagulant therapy might be useful in preventing revascularization. CI - Copyright (c) 2022 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - Kuyama, Naoto AU - Kuyama N AD - Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. FAU - Kaikita, Koichi AU - Kaikita K AD - Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan. Electronic address: koichi_kaikita@med.miyazaki-u.ac.jp. FAU - Ishii, Masanobu AU - Ishii M AD - Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. FAU - Mitsuse, Tatsuro AU - Mitsuse T AD - Division of Cardiology, Arao City Hospital, Arao, Japan. FAU - Nakanishi, Nobuhiro AU - Nakanishi N AD - Division of Cardiology, Arao City Hospital, Arao, Japan. FAU - Fujisue, Koichiro AU - Fujisue K AD - Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. FAU - Otsuka, Yasuhiro AU - Otsuka Y AD - Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. FAU - Hanatani, Shinsuke AU - Hanatani S AD - Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. FAU - Sueta, Daisuke AU - Sueta D AD - Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. FAU - Takashio, Seiji AU - Takashio S AD - Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. FAU - Araki, Satoshi AU - Araki S AD - Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. FAU - Yamamoto, Eiichiro AU - Yamamoto E AD - Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. FAU - Matsushita, Kenichi AU - Matsushita K AD - Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. FAU - Tsujita, Kenichi AU - Tsujita K AD - Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20220404 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 RN - 0 (Anticoagulants) SB - IM MH - Anticoagulants/adverse effects MH - Chronic Disease MH - Chronic Limb-Threatening Ischemia MH - Humans MH - Ischemia/diagnosis/therapy MH - Limb Salvage MH - *Peripheral Arterial Disease/diagnosis/therapy MH - Retrospective Studies MH - Risk Factors MH - *Thrombosis/prevention & control MH - Treatment Outcome OTO - NOTNLM OT - AR(10)-AUC(30) OT - Chronic limb-threatening ischemia OT - T-TAS OT - Target lesion revascularization EDAT- 2022/04/08 06:00 MHDA- 2022/07/27 06:00 CRDT- 2022/04/07 20:11 PHST- 2021/12/23 00:00 [received] PHST- 2022/03/21 00:00 [accepted] PHST- 2022/04/08 06:00 [pubmed] PHST- 2022/07/27 06:00 [medline] PHST- 2022/04/07 20:11 [entrez] AID - S0741-5214(22)01368-4 [pii] AID - 10.1016/j.jvs.2022.03.874 [doi] PST - ppublish SO - J Vasc Surg. 2022 Aug;76(2):513-522.e3. doi: 10.1016/j.jvs.2022.03.874. Epub 2022 Apr 4.