Balloon Angioplasty versus Implantation of Nitinol Stents in the Superficial Femoral Artery

Abstract

In the intermediate term, treatment of superficial-femoral-artery disease by primary implantation of a self-expanding nitinol stent yielded results that were superior to those with the currently recommended approach of balloon angioplasty with optional secondary stenting. (ClinicalTrials.gov number, NCT00281060.).

Endovascular Therapy for Femoropopliteal Disease: Drug-Eluting Stents Are Not the Default Therapy

“…To date, there remains no clear-cut de facto gold therapy for endovascular applications in the lower limb with the best outcomes that we can apply to most if not all our patients who present with symptomatic lower limb disease (Table). Current data from numerous trials at various lengths of outcome duration (ranging from 12 to 60 months) [2][3][4][5][6][7][8][9][10][11][12][13] have shown that there remains a consistent but steady decline in primary patency with all devices over time. There has been a robust interest in what should be the default therapy for lower extremity disease.…”

Drug-Eluting Stents Are the Default Strategy for Superficial Femoral Artery Intervention Now

“…23,25,26 longer lesions show more frequent restenosis (≈50%) than shorter lesions. 26,52 There is no definitive treatment for ISR.…”

“…21 Remarkably, after >40 years, PTA remains the standard of reference for all percutaneous technologies. [22][23][24][25][26][27][28][29][30][31] The appeal of endovascular therapy was obvious. Conscious sedation and local anesthesia completely sidestepped the complexity, risk, and expense of general anesthesia.…”

“…These weaknesses have served as stimuli for the development of a broad selection of supplemental or alternative endovascular treatments. 5,22 Mechanical plaque removal (atherectomy), 37 laser, 38 cutting or scoring balloons, 39 drug-eluting balloons (DEBs), 29 bare metal stents (BMS), 23 PTFE-covered stents, 40 and DES 28 are among the most common options proffered.…”

“…[23][24][25] Schillinger randomly assigned 104 patients with FP stenosis or occlusion (mean length 13 cm) to BMS or PTA. Stenting was performed in 32% of the PTA group because of a suboptimal result.…”