Balloon Angioplasty Versus Bailout Stenting for Isolated Chronic Total Occlusions in the Popliteal Artery

Abstract

Stenting of the popliteal artery (PA) is generally considered inappropriate due to the high mechanical stress and bending of the artery during knee flexion. Nevertheless, vessel recoil remains problematic following angioplasty procedure for chronic total occlusions (CTOs) and adjunctive stenting may be required. The purpose of this study is to compare balloon angioplasty alone versus bailout stenting for isolated CTO of the PA. Materials and Methods: Between March 2012 and October 2016, 43 patients were treated with percutaneous transluminal angioplasty with balloon alone (PTA, n ¼ 16) or bailout stenting percutaneous transluminal angioplasty and stenting (PTAS, n ¼ 27) for de novo CTO of PA. There was no statistically significant difference between both groups with regard to patient demographics and lesions characteristics (calcification severity and lesion length). The median lesion lengths were 67 mm (39.5-78.5) in the PTA group and 94 mm (50-114) in the PTAS group (p ¼ 0.14). The primary outcome measure was primary patency; secondary outcomes were technical success, primary assisted patency, major amputation, and increased Rutherford classification. Results: Technical success rate was 37% and 96.3% in the PTA and PTAS groups, respectively. There was no statistical difference in 12-month primary patency rate (65.8% versus 58.7%; p ¼ 0.15) and primary assisted patency at 12 months (75.2 versus 69.2; p ¼ 0.47) between the 2 groups. Freedom from target lesion revascularization at 12 months was not significantly different, with 85.7% and 81.6% (p ¼ 0.2) in the PTA and PTAS groups, respectively. One amputation occurred in the PTA group. Conclusion: This small cohort suggests that stenting as a bailout procedure in CTO of the PA provides similar results to successful balloon angioplasty. Stenting should only be performed after suboptimal balloon angioplasty with vessel recoil. Due to the large lost to follow-up, strong evidence of a therapy over the other cannot be formulated. Larger studies with longer and stronger follow-up are needed to confirm those results.

Real-World Results of Supera Stent Implantation for Popliteal Artery Atherosclerotic Lesions: 3-Year Outcome

“…In the case of isolated chronic total occlusions of the popliteal artery, during this year, a study with 43 patients comparing PTA (16) versus PTA and stenting (27) has been published. 18 The primary patency results after 12 months of follow-up were similar in both groups (65.8% vs. 58.7%), so the authors recommended stenting only in cases with vessel recoil or suboptimal PTA. The stents included into this report were common nitinol stents (52%) and interwoven stents (48%).…”

Mid-term results and predictors of restenosis in patients undergoing endovascular therapy for isolated popliteal artery steno-occlusive disease

“…The following treatment methods were used in these studies: (1) angioplasty with plain balloons, (2) PTA with drugcoated balloons, (3) stenting with bare-metal stents, (4) stentgraft implantation, (5) directional atherectomy, and (6) combinations of the above [1][2][3][4][5][6][7]13]. For the majority of studies (similar to this study), PTA with plain balloons and stenting (either primary or selective) with bare-metal stents was the technique of choice [1,2,[5][6][7]10]. The type of stents implanted varies from study to study [1,2,[5][6][7][8][9][10][11].…”

“…The mid-and long-term efficacy of endovascular procedures can be characterized by the restenosis rate. Depending on radiological intervention types, the restenosis rate of popliteal endovascular therapy is approximately 5-70% [1][2][3][4][5][6], which is slightly better than the restenosis rate of femoropopliteal interventions (40-70%; most likely because femoral lesions are almost always longer than popliteal lesions, and the longer the treated lesion, the greater the probability of restenosis) [14,15].…”

“…In the majority of studies, a presumed atherosclerotic popliteal artery stenosis is considered isolated if the patient has no ipsilateral femoral artery stenosis, requiring invasive therapy. However, publications are heterogeneous in terms of arterial runoff and the type of radiological intervention used [1][2][3][4][5][6][7]. Although percutaneous transluminal angioplasty (PTA) with a plain or drug-coated balloon plus or minus bare-metal stenting is the most commonly applied treatment method [1,2,4,[7][8][9][10][11], reports have outlined stentgraft implantation [12] and atherectomy [3,4,13].…”

“…However, publications are heterogeneous in terms of arterial runoff and the type of radiological intervention used [1][2][3][4][5][6][7]. Although percutaneous transluminal angioplasty (PTA) with a plain or drug-coated balloon plus or minus bare-metal stenting is the most commonly applied treatment method [1,2,4,[7][8][9][10][11], reports have outlined stentgraft implantation [12] and atherectomy [3,4,13]. However, studies also appear to be inconsistent in terms of the composition of deployed (mainly self-expanding) stents [1,2,5,[7][8][9]11].…”