Self-expanding nitinol stents for treatment of infragenicular arteries following unsuccessful balloon angioplasty

Abstract

The feasibility of self-expanding nitinol stents for treatment of infragenicular arteries following unsuccessful balloon angioplasty was assessed. Options for lower limb percutaneous revascularization are limited, especially for complex vessel obstruction. Depending on the lesion and the experience of the interventionalist, the failure rate of balloon angioplasty (PTA) ranges between 10 and 40%. Until recently, no self-expanding stent for the use in the infragenicular arteries was available. This is the first report of the results for 18 consecutive patients who received 4F sheath compatible self-expanding nitinol stents following unsuccessful PTA or early restenosis. Twenty-four stents were implanted in 21 lesions for various indications residual stenosis >50% due to heavy calcification, flow-limiting dissection, occluding thrombus resistant to thrombolyis, thrombaspiration, and PTA, and early restenosis after previous PTA. Stent implantation was feasible in all cases. No complications occurred. After the stent implantation, all primarily unsuccessful interventions could be transformed into successful procedures with no residual stenosis >30% in any case. After 6 +/- 2 months, two of the 18 patients died, and 14 of the 16 remaining patients improved clinically. At follow-up, the patency could be assessed in 14 stented arteries. Three stents were occluded, one stent showed some neointimal hyperplasia (50-70% restenosis), the remaining ten stents showed no restenosis (0-30%). The use of self-expanding nitinol stents in tibioperoneal and popliteal arteries is a safe and feasible option for the treatment of unsuccessful PTA. The 6-months patency is high.

Bifurcated coronary stents for infrapopliteal angioplasty in critical limb ischemia

“…With advances in endovascular therapy and technologies, together with the development of specifically designed materials for infrapopliteal arteries, [24][25][26] such as absorbable, carbofilm-coated, and coronary drug-eluting stents, 6,27,28 interest in primary and secondary stent-supported BTK angioplasty for CLI has increased. In a meta-analysis published in 2008 with 640 patients with predominantly straight in-line arterial flow treatment, the primary patency rate was 78.9%, the limb salvage rate was 96.4%, and Rutherford class improved in 91.3%.…”

Revascularization of Tibial and Foot Arteries: Below the Knee Angioplasty for Limb Salvage

“…Finally, we want to express our opinion about stent deployment in the BTK district. In literature is reported the use of stent for various indications such as dissections, calcified restenosis, recoiling and thrombus formation ( Tepe G, et al 2007), with good clinical results. We are in accord with the concept that stent use translates in acute high technical success and good short-term patency rate, but the re-stenosis rate related to neo-intimal hyperplasia is very high and the presence of stent appear as a foreign body in the true or in a subintimal lumen, that makes re-intervention more complex or, sometimes, impossible.…”

Infrapopliteal Stents:Overview and Unresolved Issues

“…To date, published data are limited to small studies with the Xpert stent. 55–57 Kickuth et al 55 first reported below-the-knee application of this stent in 35 patients for treatment of lifestyle-limiting claudication (19 cases) or CLI (16 cases). The majority of stents were placed in the popliteal artery; only 13 cases of tibioperoneal stent placement were included.…”