Randomised comparison of primary stent placement versus primary angioplasty followed by selective stent placement in patients with iliac-artery occlusive disease

Abstract

There were no substantial differences in technical results and clinical outcomes of the two treatment strategies both at short-term and long-term follow-up. Since angioplasty followed by selective stent placement is less expensive than direct placement of a stent, the former seems to be the treatment of choice for lifestyle-limiting intermittent claudication caused by iliac artery occlusive disease.

Current Trends and outcomes: Endovascular Management in Arteriosclerosis Obliterans (ASO) of Lower Limb Vessels

“…[36] The advantages of implanting a stent have been assessed in clinical trials, with comparatively better permeability figures in systematic stenting as compared with simple balloon angioplasty. [37,38,39] The best approach is probably to implant a stent selectively in those patients in whom balloon angioplasty shows an initially suboptimal result ( Figure 3). In general, we can say that short lesions, less than 10 cm, preferably with stenosis, are the most suitable for endovascular treatment.…”

“…The Dutch Iliac Stent Trial comparing stenting with balloon angioplasty and provisional stenting resulted in comparable clinical outcomes, although this may have been caused by relatively low complexity Trans Atlantic Society Consensus. [86,87] Due to increased recoil seen with ostial iliac disease, the use of primary stenting has been increased for aortoiliac disease. [88] Primary stenting shows high patency rates in a meta-analysis study on 958 total patients suffering from more complex aortoiliac disease.…”

SCAI expert consensus statement for aorto‐iliac arterial intervention appropriate use

“…Lesion significance may also be confirmed by the documentation of a pressure gradient across the lesion. With respect to what constitutes a significant translesional gradient, differing opinions exist, ranging from a mean resting gradient of 5 mmHg (ACC/AHA guidelines) [4] to a mean resting gradient of 10 mmHg (DIST) [9] as significant. For indeterminate lesions, some have advocated the use of intra-arterial papaverine (20 mg) to measure a translesional gradient during hyperemia [10,11].…”

“…Several studies have compared the outcomes of percutaneous transluminal angioplasty (PTA) with provisional stenting to primary stenting for both iliac stenosis and occlusions [20][21][22] The Dutch iliac stent trial found that PTA with provisional stenting (for a residual gradient of >10 mmHg) had similar results to primary stenting [9] However, this study excluded patients with more complex lesions (lesions >10 cm or CTO's >5 cm). By employing a provisional stenting strategy in the iliac artery, stent placement was avoided in 63% of the lesions.…”

Caracterização do perfil dos componentes do sistema das cininas, óxido nítrico e metaloproteinases como marcadores na reestenose precoce de <i>stents</i> revestidos pós angioplastia transluminal percutânea periférica

“…A ATP de artérias elásticas de maior calibre, como carótidas internas e ilíacas, está associada com menores taxas de reestenose se comparada com artérias musculares, como no segmento FP (JEANS et al, 1990;MATSI et al, 1994;TETTEROO et al, 1998;DORMANDY;RUTHERFORD, 2000;AHMADI et al, 2001), e especula-se que essas diferenças sejam decorrentes da extensão do processo inflamatório em resposta ao tratamento endovascular.…”