Wire-Interwoven Nitinol Stent Outcome in the Superficial Femoral and Proximal Popliteal Arteries

Abstract

P eripheral artery disease (PAD) is common, affecting between 8 and 12 million US residents. [1][2][3] Treatment strategies are well defined for aortoiliac vessels, 4 yet the initial success and durability of endovascular therapy in the femoropopliteal artery is limited by the diffuse nature of the disease, presence of calcification, heavy plaque burden, and high prevalence of total occlusion. Furthermore, dynamic forces (compression, torsion, bending, lengthening, Background

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

“…However there remains no impediment to retherapy and no limit to the options for retherapy, because there is an absence of an endoprosthesis. [10][11][12][13][14][15][16][17] The recent data from DEFInITIVE Ar 12 suggest that a combined therapy of atherectomy with drug-coated balloons (DCBs) may provide a signal that allows similar 1-year outcomes to the most robust randomized trial using DES. In addition, 24-month outcome data will evaluate whether there is late catch-up or failure.…”

“…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-Coated Balloon Versus Standard Balloon for Superficial Femoral Artery In-Stent Restenosis

“…As a result of guideline recommendations encouraging mainly an endovascular first-line approach 1,2 and the development of new-generation nitinol stents, stenting of femoropopliteal lesions has become mainstream in recent years. However, midterm and long-term primary patency rates are suboptimal, with 1-year primary patency of 65% to 81% [3][4][5][6] for slotted-tube nitinol stents, 83% to 86% for interwoven-wire nitinol stents, 7,8 and 83% 9 for drug-eluting stents. Five-year primary patency after endovascular therapy is reported to be 50% for TransAtlantic InterSociety Consensus A to C lesions and 34% for D lesions.…”

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

“…[47][48][49] This device is the most expensive bare metal stent, requires meticulous vessel preparation, and is technically challenging to deploy. These data lend strong support to stent placement being superior to PTA as a means to reduce restenosis and TlR, and to improve meaningful clinical outcomes.…”