One-year Clinical Outcome after Primary Stenting for Trans-Atlantic Inter-Society Consensus (TASC) C and D Femoropopliteal Lesions (The STELLA “STEnting Long de L'Artère fémorale superficielle” Cohort)

Abstract

Primary stenting of TASC C and D lesions appears to be safe and efficient given the high-sustained clinical improvement and the low rate of ISR observed in our study. Endovascular treatment of such long and severe lesions exposes to high rate of stent fractures, which should not be a concern given their low clinical impact.

Sustained Benefit at 2 Years for Covered Stents Versus Bare-Metal Stents in Long SFA Lesions: The VIASTAR Trial

“…At 1 year, the primary patency rate was 64 %, and freedom from TLR was 68 %. In the STELLA trial, a single-center registry of BMS for femoropopliteal lesions with a mean lesion length of 22 cm, 1-year primary and secondary patency rates of 66 and 80.9 % with a sustained clinical improvement of 69 % were reported [9]. However, in TASC D lesions, the clinical improvement was only 46 %.…”

“…However, the durability of percutaneous transluminal balloon angioplasty (PTA) for long SFA lesions remains poor [3,4]. Primary stent placement in long SFA lesions has shown promising results in single-arm studies [5][6][7][8][9][10]. However, in bare-metal stents (BMS) the risk of in-stent restenosis and stent fracture grows with lesion length [11].…”

Clinical Outcomes of the Intraluminal Approach for Long Occlusive Femoropopliteal Lesions Assessed by Intravascular Ultrasound

“…Restenosis was defined as a peak systolic velocity ratio of > 2.4 on duplex ultrasonography or > 50% diameter stenosis or occlusion on quantitative vascular angiography 17) . Target lesion revascularization (TLR) was defined as the need for repeated procedures (endovascular or surgical) because of a problem arising from the lesion (+1 cm proximally and distally to include edge phenomena) 6) . The definition of stent thrombosis was the same as described elsewhere 18) .…”

“…For EVT of complex lesions, such as TransAtlantic Inter-Society Consensus (TASC II) types C or D, the primary patency rate at 12 months after self-expandable stent placement is reportedly 66%–78% 3–6) , which is acceptable. The intraluminal and subintimal approaches are selected in EVT for long occlusive lesions.…”

“…The intraluminal and subintimal approaches are selected in EVT for long occlusive lesions. Although the clinical outcomes after the subintimal approach for long occlusive lesions have been reported 6–9) , relatively few studies have investigated the clinical outcomes after the intraluminal approach for such lesions, and the outcomes of the intraluminal approach has not yet been accurately evaluated by intravascular ultrasound (IVUS). Therefore, the aim of this study was to evaluate the relationship between preprocedural and postprocedural IVUS findings and restenosis at 12 months after stent implantation for long occlusive lesions using the intraluminal approach.…”