Resetting the Game for Endovascular Treatment of Tosaka III Femoropopliteal In Stent Re-stenosis

The multicentre study by Li et al. described findings investigating the endovascular management of the most challenging (Tosaka III) femoropopliteal in stent re-stenosis (ISR) cases.1 It included 353 revascularisations in 322 patients with a Tosaka III femoropopliteal ISR, where over 50% were Rutherford ≥ 4, with a mean ankle–brachial index (ABI) of 0.34 ± 0.2 and a mean lesion length of 22.0 ± 10.5 cm. Not surprisingly, given this disease complexity, the 24 month results in this large prospective cohort showed a high clinically driven target lesion revascularisation (CD-TLR) rate of 21.4% and a major adverse limb event (MALE) rate of 27.2%.