Sirolimus for below the knee lesions: Mid‐term results of SiroBTK study

Commeau, Philippe; Barragan, Paul; Roquebert, Pierre-Olivier

doi:10.1002/ccd.20893

Cited by 90 publications

(51 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…While this strategy appears to be both safe and feasible, trials comparing balloon angioplasty to bare-metal stents have not been done, and it remains to be proven that infrapopliteal stent placement improves clinical outcomes [12]. Recently, in an attempt to improve long-term patency, coronary drug-eluting stents have also been placed below the knee [13][14][15]. Because continued patency of infrapopliteal vessels correlates with improved clinical outcomes in patients undergoing peripheral bypass surgery [16] and coronary drug-eluting stents markedly reduce restenosis compared to bare metal stents [17][18][19], strategies that maximize stent patency would be expected to yield improved clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Infrapopliteal drug‐eluting stents for chronic limb ischemia

Grant

White

Collins

et al. 2007

Cathet Cardio Intervent

View full text Add to dashboard Cite

Objective: We report our experience with the elective placement of below-knee, drugeluting stents in patients with chronic limb ischemia. Background: Infrapopliteal percutaneous transluminal angioplasty has been associated with a lower rate of procedural success and high rate of restenosis because of the small size of the tibial vessels and the prevalence of calcified and diffuse atherosclerotic disease. Prior published data reports 3-year patency rates below 25%. Bare metal stents have been reported in bailout situations. Drug-eluting stents have markedly reduced restenosis compared to bare metal stents in the coronary vasculature, but there is little data supporting the use of these devices below the knee. Methods: Elective placement of drug-eluting stents in infrapopliteal lesions was performed on 10 patients with severe (≥Fontaine Stage IIb) claudication (n 5 1) or limb-threatening ischemia (n 5 9) (rest pain, nonhealing ulcers and gangrene). Results: A total of 17 drug-eluting stents were electively placed in 12 below-knee arteries in 10 patients, resulting in an average of 1.7 6 0.7 stents per patient. The mean lesion length was 24.8 6 10.9 mm, the mean total stent length was 38.3 6 19.1 mm, and the mean nominal stent diameter was 2.8 6 0.3 mm. One patient required target vessel revascularization (TVR) at 3 weeks because of stent thrombosis. TVR was 10% at 12.4 6 6.5 months of follow-up. Clinically driven angiography in three different patients was performed at 4, 15, and 16 months and confirmed drug-eluting stent patency in each case. Conclusions: The use of below-knee drug-eluting stents is feasible and appears to be safe in our small series of complex infrapopliteal lesions causing chronic limb ischemia. The occurrence of a single case of stent thrombosis warrants continued observation in this cohort. Prospective clinical trials will be necessary to confirm the benefits and justify the costs of this strategy for treating patients with infrapopliteal culprit lesions and chronic limb ischemia. '

show abstract

Section: Discussionmentioning

confidence: 99%

Infrapopliteal drug‐eluting stents for chronic limb ischemia

Grant

White

Collins

et al. 2007

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…21 The procedural success and 1-month limb salvage rates were both 100%. The primary patency rate following DES use, as determined by Doppler US, was 97% at 8 months.…”

Section: Iliac Interventionmentioning

confidence: 94%

Endovascular therapy for critical limb ischemia

Arain

White

2008

Vasc Med

View full text Add to dashboard Cite

Chronic critical limb ischemia (CLI) occurs when arterial perfusion is reduced below a threshold level that results in rest pain and/or tissue breakdown in the lower extremities. Importantly, it is associated with high cardiovascular morbidity and mortality. Without prompt revascularization, CLI may result in loss of a limb (i.e. amputation) and/or life. The goal of endovascular therapy is the re-establishment of pulsatile, straight-line flow to the distal extremity. Percutaneous transluminal angioplasty (PTA) has been shown to be effective and safe in the setting of CLI, with limb salvage rates that compare favorably with surgical procedures. Stents are indicated for failed PTA, while adjunctive therapies such as lasers, thermal angioplasty and atherectomy devices lack data demonstrating improved efficacy compared with conventional lower extremity interventions. In addition to successful revascularization, the institution of lifestyle changes, atherosclerotic risk factor modification, and pharmacologic therapies are indicated to reduce cardiovascular morbidity and mortality.

show abstract

“…For patients with severely symptomatic claudication unresponsive to medical therapy and an aggressive exercise program, infrapopliteal angioplasty, atherectomy, and stenting should be considered. The use of DES has been described for below-theknee revascularization with a low restenosis rate (133,134). This has also led to the approval in Europe of the BE sirolimus-eluting stent Cypher (Cordis) for this indication.…”

Section: Infrainguinal Diseasementioning

confidence: 98%

Current Treatment of Peripheral Arterial Disease

Mahmud

Cavendish

Salami

2007

Journal of the American College of Cardiology

View full text Add to dashboard Cite

Despite advances in medical therapies to help prevent the development of atherosclerosis and improve the management of patients with established peripheral arterial disease (PAD), the prevalence of PAD and associated morbidity remains high. Over the past decade, percutaneous revascularization therapies for the treatment of patients with PAD have evolved tremendously, and a great number of patients can now be offered treatment options that are less invasive than traditional surgical options. With the surgical approach, there is significant symptomatic improvement, but the associated morbidity and mortality preclude its routine use. Although newer percutaneous treatment options are associated with lower procedural complications, the technical advances have outpaced the evaluation of these treatments in adequately designed clinical studies, and therapeutic options are available that may not have been rigorously investigated. Therefore, for physicians treating patients with PAD, an understanding of the various therapies available, along with the inherent benefits and limitations of each treatment option is imperative as a greater number of patients with PAD are being encountered.

show abstract

Sirolimus for below the knee lesions: Mid‐term results of SiroBTK study

Abstract: Treatment of "below-the-knee" lesions with SES may provide an alternative treatment for patients with CLI.

Cited by 90 publications

References 16 publications

Infrapopliteal drug‐eluting stents for chronic limb ischemia

Infrapopliteal drug‐eluting stents for chronic limb ischemia

Endovascular therapy for critical limb ischemia

Current Treatment of Peripheral Arterial Disease

Contact Info

Product

Resources

About