The evaluation of primary stenting of sirolimus-eluting versus bare-metal stents in the treatment of atherosclerotic lesions of crural arteries

Abstract

A comparison was made of sirolimus-eluting stents and bare stents as an effective means of treatment of stenosis in crural arteries. Patients were randomly divided into two groups: (1) patients treated with sirolimus-eluting stents and (2) patients treated with bare stents. Each group consisted of 25 patients, and every patient had one stent implanted. All patients showed symptoms of ischemia of the peripheral arteries, classified according to the Rutherford scale into categories 3, 4, and 5. All patients were examined 24 h before and 24 h and 6 months after the intervention. The results were analyzed according to clinical, hemodynamic, and angiographic criteria. Technically, the procedure was successful in 100% of cases, and both groups presented an equal improvement in clinical and hemodynamic parameters. The follow-up angiographic examination demonstrated a significantly lower rate of restenosis among the sirolimus-eluting stent group (4, 16%) versus the bare stent group (19, 76%) (p < 0.001), with lower target lesion revascularization in 3 (12%) versus 14 (56%) (p < 0.05), respectively. Quantitative angiography demonstrated that all variables used to assess restenosis were superior for sirolimus-eluting stents 6 months after intervention: late lumen loss 0.46 +/- 0.72 versus 1.70 +/- 0.94 (p < 0.001) and minimal lumen diameter 2.25 +/- 0.82 versus 0.99 +/- 1.08 (p < 0.001). Results of this study reveal that the use of sirolimus-eluting stents decreases the risk of restenosis in comparison to standard stents.

Systematic Review and Meta-Analysis of Balloon Angioplasty Versus Primary Stenting in the Infrapopliteal Disease

“…22 Since the first use of stent in the infrapopliteal artery in 1993, 23 stent implantation in the infrapopliteal territory is rapidly growing. The emergence of DES encouraged the application of stenting in infrapopliteal disease.…”

Recanalization of infrapopliteal occlusions

“…Recent studies of small numbers of patients with CLI suggest sirolimus-eluting balloonmounted stents in the crural vessels retain a significant advantage over bare-metal (steel) stents at 6-month follow-up in terms of restenosis (16 vs 76%) and the need for target lesion revascularization [47]. This is important, as the options for endovascular reintervention are markedly limited once reocclusion occurs.…”

Review: Hemodynamic Studies for Lower Limb Amputation and Rehabilitation

“…Another treatment attracting much interest is stent implantation [21][22][23][24] including the application of drug eluting stent. [25][26][27] From these valuable researches, it can be learned that endovascular stenting is an effective approach to avoid the problems after balloon angioplasty, such as early elastic recoil, residual stenosis and flow limiting dissection. And stenting combined with revascularization is a feasible and safe therapy providing a good short-term vascular patency rate and hemodynamic improvements (ankle-brachial index, treadmill walking distance, etc) to treat critical limb ischemia.…”