Dutch Iliac Stent Trial: Long-term Results in Patients Randomized for Primary or Selective Stent Placement

Klein, Willemijn M.; Graaf, Yolanda van der; Seegers, J.; Spithoven, J. H.; Buskens, Erik; Baal, Jeff G. van; Buth, Jaap; Moll, Frans L.; Overtoom, T. T. C.; Sambeek, Marc R.H.M. van; Mali, Willem P.Th.M.

doi:10.1148/radiol.2382041053

Cited by 115 publications

(64 citation statements)

References 29 publications

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“…The Dutch Iliac Stent Trial comparing stenting with balloon angioplasty and provisional stenting resulted in comparable clinical outcomes although this may have been caused by relatively low complexity TASC (TransAtlantic Society Consensus) A and B disease included in the trial. 25,26 Given the increased recoil seen with ostial iliac disease and risk of dissection with the more complex disease now more frequently encountered (ie, total occlusions, ulcerated or calcified lesions, and aneurysmal segments) the use of primary stenting for aortoiliac disease has increased. 27 A meta-analysis including 958 total patients with more complex aortoiliac disease found superior patency rates associated with primary stenting.…”

Section: Aortoilliac Diseasementioning

confidence: 99%

Endovascular Intervention for Peripheral Artery Disease

Thukkani

Kinlay

2015

Circulation Research

226

158

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Advances in endovascular therapies during the past decade have broadened the options for treating peripheral vascular disease percutaneously. Endovascular treatment offers a lower risk alternative to open surgery in many patients with multiple comorbidities. Noninvasive physiological tests and arterial imaging precede an endovascular intervention and help localize the disease and plan the procedure. The timing and need for revascularization are broadly related to the 3 main clinical presentations of claudication, critical limb ischemia, and acute limb ischemia. Many patients with claudication can be treated by exercise and medical therapy. Endovascular procedures are considered when these fail to improve quality of life and function. In contrast, critical limb ischemia and acute limb ischemia threaten the limb and require more urgent revascularization. In general, endovascular treatments have greater long-term durability for aortoiliac disease than femoral popliteal disease. Infrapopliteal revascularization is generally reserved for critical and acute limb ischemia. Balloon angioplasty and stenting are the mainstays of endovascular therapy. New well-tested innovations include drug-eluting stents and drug-coated balloons. Adjunctive devices for crossing chronic total occlusions or debulking plaque with atherectomy are less rigorously studied and have niche roles. Patients receiving endovascular procedures need a structured surveillance plan for follow-up care. This includes intensive treatment of cardiovascular risk factors to prevent myocardial infarction and stroke, which are the main causes of death. Limb surveillance aims to identify restenosis and new disease beyond the intervened segments, both of which may jeopardize patency and lead to recurrent symptoms, functional impairment, or a threatened limb.

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Section: Aortoilliac Diseasementioning

confidence: 99%

Endovascular Intervention for Peripheral Artery Disease

Thukkani

Kinlay

2015

Circulation Research

226

158

View full text Add to dashboard Cite

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“…Balloon-expandable stents (Palmaz; Johnson and Johnson Interventional Systems, which is stainless steel stent) were used in DIST. One-year patency rate of iliac stenting was roughly 90% [8]. A prospective, multicenter study stated that the balloon-expandable Assurant cobalt chromium iliac stent demonstrated sustained patency with obvious improvements.…”

Section: Discussionmentioning

confidence: 99%

İliyak arter ve infrainguinal arter tıkayıcı hastalığında hybrid strateji

Sarıçam¹,

Sağlam²,

Beton³

et al. 2017

TURKISH JOURNAL of CLINICS and LABORATORY

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Aim:The treatment of peripheral arterial disease has encompassed different therapy options. Hybrid therapy method (endovascular treatment plus surgery) has recently been used in lower extremity arterial disease. This study has examined hybrid therapy practice in iliac and infrainguinal arterial disease. Materials and Methods: This study included 76 patients with occlusive iliac artery disease and performed iliac artery endovascular treatment from January 2010 to August 2015. While 56 patients underwent only iliac artery stenting, 20 of 76 patients underwent additionally infrainguinal vascular surgery (hybrid therapy).Results: In 20 hybrid patients group, iliac artery lesion length was 31.0 ± 7.6 mm. Seven patients had TASC-II A iliac artery class, while 13 patients had TASC-II B class. According to femoropopliteal lesions, eight patients had TASC-II C, while 12 patients had TASC-II D. One patient died in postoperative period. Graft stenosis developed in one patient, which was resolved through catheter therapy. In the one-year follow-up, in one patient, iliac stent restenosis developed, ABI was 0.91 ± 0.20. Conclusion:Hybrid therapy is a feasible option for multilevel lower extremity artery disease, including iliac artery disease and TASC-II C or D femoropopliteal disease. This technique has favorable patency with lower complication rates.

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“…So far, the coating with polytetrafluorethylene (Teflon) has not been able to reduce hyperplasia response (20) . Comparative studies between the primary use of stents and utilization of stents in selected cases where catheter balloon angioplasty failed to show good outcomes (21) suggest that stenting should only be used in the iliac arteries, in case of failure of percutaneous transluminal angioplasty with catheter balloon. On the other hand, the type of material utilized in the composition of the stents utilized in the present study -stainless steel and nitinol -did not present differences as far as neointimal hyperplasia is concerned.…”

Section: Discussionmentioning

confidence: 99%

Quantificação volumétrica da hiperplasia neointimal em artérias ilíacas após implante de suporte intravascular metálico

et al. 2009

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OBJECTIVE: To quantify neointimal hyperplasia in iliac arteries after stent implantation, correlating clinical, arterial factors and stent material. MATERIALS AND METHODS: In the period from June/2003 to August/ 2005, 60 patients were submitted to percutaneous transluminal angioplasty and stenting. Among these patients, 30 were followed-up with intravascular ultrasonography. Data were analyzed in a laboratory of quantitative analysis by means of a specific software. RESULTS: Sixteen (53.3%) patients were men, and 14 (46.7%), women, and the mean age was 60.3 years. Arterial hypertension was observed in 22 patients (73.3%), smoking in 18 (62.1%), hyperlipidemia in 20 (66.7%), and diabetes in 9 (30%). A total of 20 nitinol stents (66.7%) and 10 stainless steel stents (33.3%) were implanted. Four patients were classified as TASC A (13.3%), 15 TASC B (50%) and 11 TASC C (36.7% ). The rate of intrastent obstruction ranged from 18% to 47% (mean, 27.4%). The clinical outcomes achieved with stenting were sustained through the follow-up. CONCLUSION: Neointimal hyperplasia is a common finding after percutaneous transluminal angioplasty and stenting, but in the present study the stenosis rate was never higher than 50%. There was no statistically significant difference in intrastent stenosis rates in relation to stents materials, clinical and arterial risk factors. Keywords: Stent; Iliac artery; Interventional ultrasonography; Hyperplasia.OBJETIVO: Quantificar a hiperplasia neointimal em artérias ilíacas após stent, correlacionando fatores clíni-cos, arteriais e materiais dos stents. ). O percentual de obstrução intra-stent variou de 18% a 47% (média de 27,4%). Os resultados clínicos obtidos com stent se mantiveram até o reestudo. CONCLUSÃO: A hiperplasia neointimal sempre ocorre após a angioplastia transluminal percutânea e stent, porém os percentuais de obstrução não foram superiores a 50% em nenhum caso. Não houve diferença estatisticamente significante dos percentuais de obstrução intra-stent quanto aos materiais dos stents, aos fatores clínicos e aos fatores arteriais. Unitermos: Stent; Artéria ilíaca; Ultrassonografia de intervenção; Hiperplasia. Intra-stent restenosis caused by neointimal hyperplasia has its occurrence peak around the sixth postoperative month (Figure 1), and it has been described in other locations such as the coronary arteries although such occurrence has not been reported with the same frequency as in the case of iliac arteries.In the present study, intravascular ultrasonography (IVUS) was performed to quantify the volume of neointimal hyperMoreira SM, Kambara AM, Ajzen S, Costa Junior JR. Volumetric assessment of neointimal hyperplasia in iliac arteries after metal stent implantation. Radiol Bras. 2009;42(4):231-234.

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Dutch Iliac Stent Trial: Long-term Results in Patients Randomized for Primary or Selective Stent Placement

Abstract: Patients treated with PTA and selective stent placement in the iliac artery had a better outcome for symptomatic success compared with patients treated with primary stent placement, whereas data about iliac patency, ABI, and quality of life did not support a difference between groups.

Cited by 115 publications

References 29 publications

Endovascular Intervention for Peripheral Artery Disease

Endovascular Intervention for Peripheral Artery Disease

İliyak arter ve infrainguinal arter tıkayıcı hastalığında hybrid strateji

Quantificação volumétrica da hiperplasia neointimal em artérias ilíacas após implante de suporte intravascular metálico

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