Predictors of Successful Intervention with Mechanical Rotational Thrombectomy Device in Cases of Acute Lower Limb Ischemia Due to In Stent Occlusion in Iliofemoral- Popliteal Segment

Background: Peripheral artery disease (PAD) affects millions worldwide, with in-stent restenosis (ISR) and stent thrombosis (ST) being common complications after femoropopliteal stenting. Despite advances, ST remains a challenge, often leading to acute limb ischemia and possible amputation. This study aims to identify predictors of technical and clinical success using mechanical rotational thrombectomy for acute limb ischemia due to in-stent occlusion in the iliofemoral-popliteal segment.Methods: A prospective cohort study was conducted at Ain Shams University Hospitals, Cairo, Egypt, including 45 patients with acute limb ischemia due to stent thrombosis. All patients underwent clinical, radiological, and laboratory evaluations. Technical success was defined as recanalization with minimal residual stenosis. Follow-up was performed at 7 days, 1 month, 6 months, and 12 months.Results: Technical success was achieved in 85% of cases, with significant postoperative improvement in ankle-brachial index (ABI). Early complications occurred in 17.5% of patients, mostly minor and manageable. Primary patency declined from 87.5% at 7 days to 57.5% at 12 months, while assisted and secondary patency rates remained higher. Poor prognostic factors included diabetes, hyperlipidemia, longer lesion length, lower pre- and postoperative ABI, and incomplete technical success. Logistic regression identified low postoperative ABI and the presence of complications as independent predictors of poor outcomes.Conclusions: Mechanical rotational thrombectomy offers high technical success and favorable outcomes for acute limb ischemia due to in-stent occlusion. Long-term patency is influenced by clinical and procedural factors, emphasizing the need for careful patient selection and follow-up.