Bare Metal Versus Paclitaxel-Eluting Stents for Long Femoropopliteal Lesions: Prospective Cohorts Comparison Using a Propensity Score–Matched Analysis

Vent, Pierre-Alexandre; Kaladji, Adrien; Davaine, Jean-Michel; Guyomarch, Béatrice; Chaillou, Philippe; Costargent, Alain; Quillard, Thibaut; Gouëffic, Yann

doi:10.1016/j.avsg.2016.10.058

Cited by 19 publications

(18 citation statements)

References 22 publications

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“…This result indicate that PTX-DES has no statistically significant clinical benefits and morphological outcomes for long lesions compared to bare metal stents (BMS). 9 This finding is consistent with those from another recent study, 8 which evaluated Zilver V R PTX DES in patients with longer femoropopliteal lesions (24.2 AE 11.3 cm). The study retrospectively reviewed 89 consecutive patients with femoropopliteal occlusive disease who were previously treated with the Zilver V R PTX DES between December 2012 and December 2013.…”

Section: Discussionsupporting

confidence: 92%

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A real-world experience of drug eluting and non-drug eluting stents in lower extremity peripheral arterial disease

et al. 2019

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Objectives Drug-eluting stents (DES) have been promoted as an alternative to the traditional non-drug eluting stents (nDES), and offer the potential for improved patency rates. However, DES are more expensive than nDES, and results comparing these stents outside of clinical trials have been limited. Materials and methods A retrospective review was performed on all in patient infrainguinal lower extremity endovascular procedures between January 2014 and September 2016, which involved stent implantation. Procedures involving the common femoral artery, superficial femoral artery, and above knee popliteal artery were included. Procedures involving iliac, below knee popliteal, tibial, peroneal, and pedal arteries were excluded. The type of stent, number of stents, length of each stent, and location of stent were recorded for each procedure. Data on each patients Trans-Atlantic Inter Society Consensus II class were collected. End-points included stent thrombosis, restenosis, re-intervention, and limb loss. Post-operative arterial duplexes were obtained every three months to determine stent patency during follow-up visits. In-stent stenosis was defined as >60% narrowing on arterial duplex. Thrombosis was defined as in-stent occlusion, and limb loss involved only major amputations in the treated extremity. Bivariate analysis and Students two-sample T-test were used to analyze the data. IBM-SPSS – 22 was used for all analyses. Results Two hundred and twelve patients underwent at total of 252 procedures during the study period. Of this group, 191 procedures met inclusion criteria. There were 21 lesions that were treated with both nDES and DES and they were excluded from further analysis. The average patient age was 73.2 ± 11.6 years; 68.6% had hypertension, and 58.1% had diabetes. Mean follow-up was 7.18 ± 7.96 months. The most common indication for intervention was claudication (53%), followed by critical limb threatening ischemia (47%); 124 procedures involved only nDES (Lifestent®)(Bard, Tempe, AZ), 46 procedures involved only DES (Zilver®) (Cook, Bloomington, IN). Comparison of nDES and DES showed the overall rate of thrombosis (11.1% vs. 16.7%, p = 0.81), overall rates of re-stenosis (48.2% vs. 46%, p = 1.0), re-intervention (13.7% vs. 14.3%, p = 1.0), and limb loss (9.7% vs. 0.0%, p = 0.38) was equivalent between the groups. The six-month primary patency rate for nDES and DES (41.9% vs. 40.0%, p = 1.0) was also equivalent. On average, the average lengths of nDES were longer than DES (19.2 ± 14.3 cm vs.11.4 ± 5.7 cm) ( p < .0001). DES results showed overall rates of 33% re-stenosis, 7.1% thrombosis, and no limb loss. There were no statistical differences between the nDES or DES groups with respect to gender, age, laterality, diabetes mellitus, coronary artery disease, gangrene, ulcers, hyperlipidemia, atrial fibrillation, deep vein thrombosis, claudication, critical limb-threatening ischemia, ipsilateral bypass, re-stenosis, thrombosis, limb loss, or ipsilateral amputation. Bivariate analysis showed a higher incidence of hypertension for nDES patients ( p = .001). There was no statistical difference between Trans-Atlantic Inter Society Consensus II classes and type of stent used ( p = .95). Conclusions In this retrospective analysis from one institution, the use of an nDES or DES did not result in a statistically significant difference in the rate of thrombosis, re-stenosis, ipsilateral re-intervention, or ipsilateral amputation over a two-year period when involving the CFA, SFA, and above knee popliteal artery.

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Section: Discussionsupporting

confidence: 92%

“…A recent single center prospective cohort study by Vent et al. 9 is the first to compare the clinical outcomes of PTX-DES versus non-DES (BMS) for primary stenting of long femoropopliteal lesions. Their study had lesions ≥15 cm long in 110 limbs, of which 62 were treated with nDES and 48 were treated with PTX-DES.…”

Section: Discussionmentioning

confidence: 99%

A real-world experience of drug eluting and non-drug eluting stents in lower extremity peripheral arterial disease

et al. 2019

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“…matched analysis that, according to both registries, paclitaxel-eluting stents do not seem to provide benefits in terms of clinical and morphological outcomes for TASC C/D lesions compared to bare metal stent (35). Moreover, there is an heterogeneity in the dual antiplatelet therapy (DAPT) prescription in the present cohort and even though there is no high level of evidence for DAPT after peripheral endovascular stenting, coronary studies recommended DAPT systematically for a minimum duration of 6 months to prevent in stent thrombosis (36).…”

Section: Accepted Manuscriptmentioning

confidence: 94%

Impact of Vascular Calcifications on Long Femoropopliteal Stenting Outcomes

Kaladji

Vent

Danvin

et al. 2018

Annals of Vascular Surgery

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“…Whether PEB angioplasty and stenting may further reduce restenosis and improve long-term clinical outcomes as compared with PEB angioplasty alone in SFA occlusion deserves further investigation. Drug-eluting stents do not seem to be an option for SFA occlusions because a recent registry showed that PES did not improve outcomes as compared with bare-metal stents in TASC-II C and D femoropopliteal lesions [21].…”

Section: Future Strategiesmentioning

confidence: 99%

Differential efficacy between stenting and plain balloon angioplasty for femoropopliteal disease with or without total occlusion

Chae

Yoon

et al. 2020

Korean J Intern Med

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Background/Aims: Whether the presence of chronic total occlusion (CTO) affects patency after stenting in femoropopliteal lesions is unknown. We determined the effects of plain balloon angioplasty (POBA) in comparison with those of stenting on patency for femoropopliteal CTO and stenosis (non-CTO). Methods: We analyzed data from the Korean Vascular Intervention Society Endovascular Therapy in Lower-Limb Artery Diseases Registry, a multicenter cohort of patients with lower extremity peripheral arterial disease. Data from 1,329 patients and 1558 limbs treated with endovascular intervention for at least one femoropopliteal lesion were evaluated. Results: Among the 1,558 limbs, 345, 432, 275, and 506 were in the non-CTO-PO-BA, non-CTO-stent, CTO-POBA, and CTO-stent groups, respectively. During follow-up, loss of clinical primary patency, a composite of freedom from restenosis or clinically driven target lesion revascularization, occurred in 65 (18.8%), 68 (15.7%), 62 (22.5%), and 113 limbs (22.3%) in the non-CTO-POBA, non-CTO-stent, CTO-POBA, and CTO-stent groups, respectively. The patients in the non-CTOstent group showed a significantly better clinical primary patency than those in the no-CTO-POBA group, whereas those in the CTO-stent and CTO-POBA groups showed no significant differences. After inverse probability of treatment weighting to balance the differences among covariates between the non-CTOstent and non-CTO-POBA groups, the non-CTO-stent group still showed superior clinical primary patency as compared with the non-CTO-POBA group. Conclusions: In the patients with femoropopliteal stenosis without CTO, stenting resulted in better clinical outcomes than balloon angioplasty. The presence of CTO in the femoropopliteal lesion should be considered when selecting a suitable device for performing endovascular procedures.

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Bare Metal Versus Paclitaxel-Eluting Stents for Long Femoropopliteal Lesions: Prospective Cohorts Comparison Using a Propensity Score–Matched Analysis

Cited by 19 publications

References 22 publications

A real-world experience of drug eluting and non-drug eluting stents in lower extremity peripheral arterial disease

A real-world experience of drug eluting and non-drug eluting stents in lower extremity peripheral arterial disease

Impact of Vascular Calcifications on Long Femoropopliteal Stenting Outcomes

Differential efficacy between stenting and plain balloon angioplasty for femoropopliteal disease with or without total occlusion

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