RS26 - Evaluating the Long-term Efficacy of Mechanical Thrombectomy for Venous In-stent Thrombosis: A Multicenter, Retrospective Analysis of 44 Patients

Objectives: Venous in-stent thrombosis (IST) is a common complication of venous stent placement occurring in up to 25% of patients, specifically those with postthrombotic disease. Existing IST interventions, such as venoplasty and stent relining, are limited in efficacy in reestablishing stent patency. The RevCore thrombectomy catheter has been designed to specifically treat IST; however, long-term data is sparse. In a multicenter, retrospective analysis, we evaluated the long-term efficacy of the study device.

Methods: Data from 44 patients (48 treated limbs) from 4 centers were analyzed, retrospectively, using the inclusion criteria: 1) ≥18 years old, 2) presented with lower extremity venous IST, 3) treated with the study device. The primary endpoint was postprocedural stent patency (≥50% effective stent diameter). Reintervention rates were reported. Clinical outcomes include edema, Villata score, and CEAP score (Table I). Patients are being followed up to 24 months.

Results: Mean age was 54.8 ± 17.1 years, and 23 (52.3%) patients were female. Median IST symptom duration was 8.0 (IQR, 2.0-104.0) weeks. The primary endpoint was 100%. Of the available data, at 30-day follow-up, primary patency was 94.1% (n=32), and at 6 months, 12 months, and 24 months, patency rates were 95.0% (n=19), 93.8% (n=15), and 100% (n=11), respectively (Figure 1). Over 24 months, a change in anticoagulant was noted in 2 patients. The annualized reintervention rate was 21.8%. Moderate pain was noted in 7 patients (36.8%) at 6 months and 3 patients (25.0%) at 24 months, while no patients reported severe pain at any follow-up. Mild post-thrombotic syndrome, as defined by Villalta scores 5-9, were reported in 9 patients (45.0%) at 6 months, declining to 3 patients (25.0%) at 24 months. Moderate and severe edema was reported in 19 patients (95.0%) at the 6-month follow-up, declining to 8 patients (72.7%) at 24 months. Advanced chronic venous disease, as defined by CEAP scores 5-6, were measured in 3 patients (15.0%) and 2 patients (16.7%) at the 6-month and 24-month follow-ups.

Conclusions: Mechanical thrombectomy with the study device demonstrated durable stent patency, low reintervention rate, and improved clinical symptoms over 24 months in patients with lower extremity venous IST.