A comparison study of self-expandable stents vs balloon angioplasty alone in femoropopliteal artery occlusions

Do-dai-Do,; Triller, Jürgen; Walpoth, Beat H.; Stirnemann, P; Mahler, F

doi:10.1007/bf02733955

Cited by 133 publications

(26 citation statements)

References 18 publications

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“…Do-dai et al prospectively compared primary stenting and PTA in femoropopliteal occlusions in 52 patients and reported similar 1-year patency rates of 60% and 65%, respectively. 9 Based on these reports, stent placement as the primary treatment for femoropopliteal occlusive disease is not recommended, but Henry et al recommend stenting if the results of PTA are sub-optimal and for dissections or restenosis. 8 PTA -stenting also has some advantages over bypass surgery, such as low morbidity and mortality, shorter recovery and preservation of the saphenous vein for future bypass surgery, especially in young patients.…”

Section: Discussionmentioning

confidence: 99%

Fracture of Popliteal Artery Stents

Babalık

Gülbaran

Gürmen

et al. 2003

Circ J

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tent implantation in the peripheral arteries is a safe and effective treatment not only for obstructive diseases, but also non-obstructive conditions such as aneurysm formation. 1,2 More than 50% of all obstructive lesions are located in the femoropopliteal segment where they tend to be longer and have multiple coexisting atherosclerotic lesions at different levels. Surgical revascularization is the treatment of choice for these diffuse femoropopliteal stenoses and although percutaneous transluminal angioplasty (PTA) has a high risk of occlusion, it is the recommended primary treatment. Stent implantation for femoropopliteal occlusions is not recommended because of poor patency rates, and should only be considered for major dissections after PTA because stenting has been associated with acute thrombosis, stent embolization or migration, distal embolization by plaque contents, vessel rupture or dissection. [3][4][5][6] In addition to these acute complications, late stent restenosis remains an unresolved clinical problem. Although stent fracture occurs rarely, it may contribute to or cause late stent failure when implanted in arteries near or at flexion points in the peripheral arteries. Stent fracture has occurred after iliac arterial stenting 7 and we describe a case of fracture in overlapping stents implanted in the left popliteal artery. Case ReportA 48-year-old man was referred for coronary and peripheral arteriography. He reported left calf claudication of 3 years' duration that had progressively worsened in the past few months. His complaints were pain and numbness with mild exercise. He had had non-insulin dependent diabetes mellitus for 1 year and had smoked 1 pack of cigarettes per day for 33 years. On physical examination, both his lower limbs were pale and cool. His left femoral pulse was present, but the left popliteal and left lower extremity pulses were absent. Right femoral and popliteal pulses were present, and the distal pulses in right lower extremity were also palpable. The ankle -brachial index was 0.32 for the left limb. There was not any ulcer formation related to occlusive arterial disease on either leg.The diagnostic coronary and peripheral arteriography revealed 2-vessel coronary artery disease: a severe stenosis in the proximal segment of the left popliteal artery and 50% narrowing of the right popliteal artery. There was late filling of the vasculature distal to the severely narrowed left popliteal artery (Fig 1). We used a standard angioplasty technique from an antegrade, ipsilateral puncture of the left common femoral artery with an 8F sheath. The lesion was crossed Circ J 2003; 67: 643 -645 (Received November 14, 2001; revised manuscript received January 21, 2002; accepted February 15, 2002

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Section: Discussionmentioning

confidence: 99%

Fracture of Popliteal Artery Stents

Babalık

Gülbaran

Gürmen

et al. 2003

Circ J

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“…Precise restenosis rates are lacking for the femoropopliteal region because of incomplete or absent angiographic follow-up in most studies. 19,20 Patency rates 12 months after the placement of Wallstents and Palmaz stents in mostly short SFA lesions have been reported to range from 22% to 61%. 1,14,15 Duplex ultrasound follow-up in a group of 55 patients, most of whom were treated with femoral Wallstents, showed a primary 6-month patency rate of only 47%.…”

Section: Discussionmentioning

confidence: 99%

Sirolimus-Eluting Stents for the Treatment of Obstructive Superficial Femoral Artery Disease

et al. 2002

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Background-Stent implantation for obstructive femoropopliteal artery disease has been associated with poor long-term outcomes. This study evaluated the effectiveness of shape memory alloy recoverable technology (SMART) nitinol self-expanding stents coated with a polymer impregnated with sirolimus (rapamycin) versus uncoated SMART stents in superficial femoral artery obstructions. Methods and Results-Thirty-six patients were recruited for this double-blind, randomized, prospective trial. All patients had chronic limb ischemia and femoral artery occlusions (57%) or stenoses (average lesion length, 85Ϯ57 mm). Patients were eligible for randomization after successful guidewire passage across the lesion. Eighteen patients received sirolimus-eluting SMART stents and 18 patients received uncoated SMART stents. The primary end point of the study was the in-stent mean percent diameter stenosis, as measured by quantitative angiography at 6 months. The in-stent mean percent diameter stenosis was 22.6% in the sirolimus-eluting stent group versus 30.9% in the uncoated stent group (Pϭ0.294). The in-stent mean lumen diameter was significantly larger in the sirolimus-eluting stent group (4.95 mm versus 4.31 mm in the uncoated stent group; Pϭ0.047). No serious adverse events (death or prolonged hospitalization) were reported. Conclusions-The use of sirolimus-eluting SMART stents for superficial femoral artery occlusion is feasible, with a trend toward reducing late loss compared with uncoated stents. The coated stent also proved to be safe and was not associated with any serious adverse events.

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“…Percutaneous transluminal balloon angioplasty is a low-risk and low-cost procedure, but it is associated with a fairly high restenosis rate (2)(3)(4)(5). Primary stent placement does not improve the patency rate of PTA performed for femoropopliteal arterial disease and is thus currently used only to salvage a failed balloon angioplasty procedure (6,7). Bypass surgery, on the other hand, has higher long-term patency rates but is also associated with a higher procedural risk, higher cost, and longer convalescence period (4,5).…”

Section: Discussionmentioning

confidence: 99%

Cost and Patency Rate Targets for the Development of Endovascular Devices to Treat Femoropopliteal Arterial Disease

Muradin¹,

Hunink²

2001

Radiology

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Radiology 2001; 218:464 -469Abbreviations: NHB ϭ net health benefit PTA ϭ percutaneous transluminal angioplasty QALY ϭ quality-adjusted life-year To determine the criteria that would make use of an endovascular device cost-effective compared with bypass surgery and percutaneous transluminal angioplasty in the treatment of femoropopliteal arterial disease. MATERIALS AND METHODS:A decision model was developed to compare treatment with the use of a hypothetical endovascular device with established therapies. Cost-effectiveness from the perspective of the health care system was considered. Outcome measures were lifetime costs and quality-adjusted life-years. With the use of net health benefit calculations and threshold analysis, combinations of costs and patency rates were determined that would make the device cost-effective compared with established therapies. In subgroup and sensitivity analyses, the effect on decision-making of sex, age, indication, lesion type, procedural risk, and society's willingness to pay for incremental gain in health were explored. RESULTS:Use of a device that costs $3,000 would be cost-effective compared with bypass surgery for critical ischemia if the 5-year patency rate is 29%-46%. Use of the same device would be cost-effective compared with angioplasty for disabling claudication and stenosis if the 5-year patency rate is 69%-86%. CONCLUSION:The target combinations of costs and patency rates found in this study are probably attainable, and further development of such endovascular devices seems warranted.Although bypass surgery and percutaneous transluminal angioplasty (PTA) are commonly used revascularization procedures in the treatment of femoropopliteal arterial occlusive disease, both procedures have disadvantages (1). Percutaneous transluminal balloon angioplasty is a low-risk and low-cost procedure, but it is associated with a fairly high restenosis rate (2-5). Primary stent placement does not improve the patency rate of PTA performed for femoropopliteal arterial disease and is thus currently used only to salvage a failed balloon angioplasty procedure (6,7). Bypass surgery, on the other hand, has higher long-term patency rates but is also associated with a higher procedural risk, higher cost, and longer convalescence period (4,5). In general, PTA is performed as primary treatment of short focal lesions of the femoropopliteal artery, whereas bypass surgery is the primary treatment in diffuse disease.Endovascular devices are currently being developed as alternative interventions to overcome the problems of established procedures. Important considerations in choosing the optimal treatment strategy are the effectiveness of the device, the risks of the procedures, and the costs. These parameters are generally unknown during the development of a new technology. In particular, the patency and cost estimates associated with endovascular devices are uncertain and may even change with time. It is difficult, if not impossible, to predict what the precise values for the parameters of a new te...

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A comparison study of self-expandable stents vs balloon angioplasty alone in femoropopliteal artery occlusions

Cited by 133 publications

References 18 publications

Fracture of Popliteal Artery Stents

Fracture of Popliteal Artery Stents

Sirolimus-Eluting Stents for the Treatment of Obstructive Superficial Femoral Artery Disease

Cost and Patency Rate Targets for the Development of Endovascular Devices to Treat Femoropopliteal Arterial Disease

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