Interwoven Nitinol Stents versus Drug Eluting Stents in the Femoro-Popliteal Segment: A Propensity Matched Analysis.
Aged
Alloys
/ therapeutic use
Angioplasty
/ adverse effects
Computed Tomography Angiography
/ methods
Extremities
/ blood supply
Female
Femoral Artery
/ pathology
Graft Occlusion, Vascular
/ diagnosis
Humans
Limb Salvage
/ methods
Male
Outcome and Process Assessment, Health Care
Peripheral Arterial Disease
/ pathology
Plaque, Atherosclerotic
/ diagnostic imaging
Popliteal Artery
/ pathology
Prognosis
Stents
/ adverse effects
Vascular Calcification
/ diagnostic imaging
Vascular Patency
Angioplasty
Peripheral arterial disease
Stent
Journal
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
ISSN: 1532-2165
Titre abrégé: Eur J Vasc Endovasc Surg
Pays: England
ID NLM: 9512728
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
received:
12
02
2019
revised:
11
06
2019
accepted:
13
06
2019
pubmed:
11
9
2019
medline:
9
4
2020
entrez:
11
9
2019
Statut:
ppublish
Résumé
Percutaneous transluminal angioplasty (PTA) is a common procedure in patients with peripheral arterial disease (PAD) affecting the femoropopliteal segment (F-P). Biomimetic nitinol stents (Supera peripheral stent, SPS) and drug eluting stents (DES) were designed to improve the longevity of F-P PTA; however, their performance has not been compared in a pragmatic setting, taking atherosclerotic plaque characteristics into account. Overall, 296 consecutive patients (mean age: 73 y, SD: 11 y, 65% male, 68% with chronic limb threatening ischaemia) who underwent F-P PTA using SPS or DES between 2013 and 2018 were identified from a prospectively maintained institutional database. Patient and plaque characteristics, including F-P plaque characterisation based on computed tomography, were collected; 121 case matched pairs were created using a propensity score based on patient and plaque data. During the median two year follow up, 28% of the cohort (32% SPS vs. 24% DES, p = .07) developed target lesion restenosis (TLR) > 50%. Among the 121 case matched pairs of patients, those with SPS vs. DES were not significantly more likely to develop TLR >50% (31% vs. 27%, p = .34), or stent occlusion (13% vs. 12%, p = .85 - secondary patency rate 87% vs. 88%), have a major amputation (10% vs. 6%, p = .16), require re-intervention (14% vs. 9%, p = .12), or die (7% vs.4%, p = .31). Plaque calcification did not predict restenosis or occlusion in either stent group, both in the matched and non matched populations. Multivariable analysis adjusted for patient and plaque characteristics revealed that the main predictors of restenosis >50% at two years were female sex [odds ratio (OR): 2.05, p = .01], hypertension (OR: 2.10, p = .04) and previous F-P occlusion (OR: 1.35, p = .04). Medium term results following F-P PTA with either SPS or DES are comparable, regardless of plaque calcification and patient characteristics.
Sections du résumé
BACKGROUND
BACKGROUND
Percutaneous transluminal angioplasty (PTA) is a common procedure in patients with peripheral arterial disease (PAD) affecting the femoropopliteal segment (F-P). Biomimetic nitinol stents (Supera peripheral stent, SPS) and drug eluting stents (DES) were designed to improve the longevity of F-P PTA; however, their performance has not been compared in a pragmatic setting, taking atherosclerotic plaque characteristics into account.
METHODS
METHODS
Overall, 296 consecutive patients (mean age: 73 y, SD: 11 y, 65% male, 68% with chronic limb threatening ischaemia) who underwent F-P PTA using SPS or DES between 2013 and 2018 were identified from a prospectively maintained institutional database. Patient and plaque characteristics, including F-P plaque characterisation based on computed tomography, were collected; 121 case matched pairs were created using a propensity score based on patient and plaque data.
RESULTS
RESULTS
During the median two year follow up, 28% of the cohort (32% SPS vs. 24% DES, p = .07) developed target lesion restenosis (TLR) > 50%. Among the 121 case matched pairs of patients, those with SPS vs. DES were not significantly more likely to develop TLR >50% (31% vs. 27%, p = .34), or stent occlusion (13% vs. 12%, p = .85 - secondary patency rate 87% vs. 88%), have a major amputation (10% vs. 6%, p = .16), require re-intervention (14% vs. 9%, p = .12), or die (7% vs.4%, p = .31). Plaque calcification did not predict restenosis or occlusion in either stent group, both in the matched and non matched populations. Multivariable analysis adjusted for patient and plaque characteristics revealed that the main predictors of restenosis >50% at two years were female sex [odds ratio (OR): 2.05, p = .01], hypertension (OR: 2.10, p = .04) and previous F-P occlusion (OR: 1.35, p = .04).
CONCLUSION
CONCLUSIONS
Medium term results following F-P PTA with either SPS or DES are comparable, regardless of plaque calcification and patient characteristics.
Identifiants
pubmed: 31500990
pii: S1078-5884(19)30502-7
doi: 10.1016/j.ejvs.2019.06.012
pii:
doi:
Substances chimiques
Alloys
0
nitinol
2EWL73IJ7F
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
719-727Subventions
Organisme : British Heart Foundation
ID : FS/17/24/32596
Pays : United Kingdom
Investigateurs
Prakash Saha
(P)
Said Abisi
(S)
Lukla Biasi
(L)
Bijan Modarai
(B)
Tommaso Donati
(T)
Morad Sallam
(M)
Ashish Patel
(A)
Rachel Bell
(R)
Rebecca Sandford
(R)
Michael Dialynas
(M)
Irfan Ahmad
(I)
Mark Tyrrell
(M)
Tarun Shabharwal
(T)
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.