Self-Expandable Stent Placement in Infrapopliteal Arteries After Unsuccessful Angioplasty Failure: One-Year Follow-up

Abstract

The purpose of this prospective study was to evaluate whether stent placement in infrapopliteal arteries is helpful in failed percutaneous transluminal angioplasty (PTA). Infrapopliteal PTA was performed in 70 arteries of 66 patients with chronic critical lower limb ischemia. The group comprised 55 males and 11 females, with an average age of 63.4 (range, 42-82) years. Diabetes mellitus was present in 92.4% of patients. Only the palpable anterior tibial and posterior tibial arteries were evaluated. Stents (Xpert stent; Abbot Vascular, Redwood City, CA, USA) were placed in 16 arteries where PTA was not successful (the failure was defined as residual stenosis >30% after PTA). In 54 arteries simple PTA was performed and was technically successful. Twenty-four nondilated arteries with no significant stenosis served as a comparison group. The 12-month patency rate was evaluated according to a combination of palpation and Doppler ultrasound. In all cases stent placement restored the flow in the artery immediately after unsuccessful PTA. Twelve-month follow-up showed a patency rate of 82% in the PTA group, 78% in the stent group, and 69% in the comparison group. We conclude that stent placement in the case of unsuccessful infrapopliteal PTA changed technical failure to success and restored flow in the dilated artery. At 12-month follow-up the patency rate of infrapopliteal arteries stented for PTA failure did not differ significantly either from nonstented arteries with an optimal PTA result or from a comparison group of nonintervened arteries.

Randomized comparison of everolimus-eluting versus bare-metal stents in patients with critical limb ischemia and infrapopliteal arterial occlusive disease

“…1,2,4,5 In many vascular beds, including coronary, carotid, renal, iliac, and infrainguinal arteries, the long-term patency of PTA can be augmented by intravascular stenting. Similarly, several clinical studies are now available that suggest that tibial stents enhance acute results by providing "rescue" in cases of dissection or acute occlusion (ie, "bailout stenting") 23,24 and may be appropriate as primary therapy in selected patients. 18,25,26 Whether primary stenting improves patency in all patients remains controversial, because in-stent restenosis continues to be a significant problem 4 and available comparative clinical studies have been small and the results conflicting.…”

AMS INSIGHT—Absorbable Metal Stent Implantation for Treatment of Below-the-Knee Critical Limb Ischemia: 6-Month Analysis

“…The fear that early thrombosis and late luminal loss due to intimal hyperplasia formation potentially lead to insufficient long-term patency rates can explain the reluctance on implanting stents in these small-diameter vessels. Although the limited evidence available suggests very acceptable outcomes using either passive coated stents (PCSs) [ 4 ], balloon-expandable drug-eluting stents [ 5 – 8 ], or self-expanding nitinol stents [ 9 – 12 ], target lesion revascularization (TLR) is still required in a significant percentage of patients to enable limb salvage. The permanent presence of an artificial implant is believed to be the potential trigger for late restenosis.…”

Tibial Intervention for Critical Limb Ischemia

“…19 SESs have also been shown to be safe and effective in treating obstructive atherosclerotic lesions BTK. 20,21 Patency and limb salvage rates with the use of BMS, SES, and DES are all quite similar in the short term, with limb salvage rates higher in general versus vessel patency rates (70 to 100% versus 60 to 80% at 1 year). It appears that the main use of stents in tibial intervention is for suboptimal PTA results, although primary stenting is being heavily evaluated as a first-line consideration.…”