Nitinol self-expanding stents vs. balloon angioplasty for very long femoropopliteal lesions

Ehrin J. Armstrong, Haseeb Saeed, Bejan Alvandi, Satinder Singh, Gagan D. Singh, Khung Keong Yeo, David Anderson, Gregory G. Westin, David L. Dawson, William C. Pevec, John R. Laird

Research output: Contribution to journalArticle

Abstract

Purpose: To compare the patency rates and clinical outcomes of balloon angioplasty vs. nitinol stent placement for patients with short (≤150 mm) as compared to long (>150 mm) femoropopliteal (FP) occlusive lesions. Methods: Between 2006 and 2011, 254 patients (134 men; mean age 68 years) underwent FP angioplasty. The majority of patients (64%) were treated for critical limb ischemia. One hundred thirty-nine (55%) patients had short FP lesions ≤150 mm, while 115 patients had long FP lesions >150 mm. The mean lesion length was 78±43 mm in the short FP lesion group and 254±58 mm in the long FP lesion group. Duplex ultrasound follow-up with a peak systolic velocity ratio ≥2.0 was used to define restenosis. Results: The overall procedure success rate was 98%. One hundred forty-eight (58%) patients underwent stent placement. The mean number of stents deployed for treatment of short FP lesions was 1.0±0.4 vs. 2.0±0.7 for long FP lesions (p<0.001). The primary patency rate of short FP lesions treated with balloon angioplasty vs. stenting was 66% vs. 63% at 1 year (p=0.7). For long FP lesions, the 1-year primary patency rates of balloon angioplasty vs. stenting were 34% vs. 49% (p=0.006). Balloon angioplasty of long FP lesions was also associated with significantly lower assisted primary and secondary patency compared to stenting (p<0.05 for all comparisons). Sustained clinical improvement was >90% at 30 days but declined to 62% to 75% at 1 year. Conclusion: Balloon angioplasty and stent placement result in similar patency rates and clinical outcomes for shorter to medium-length FP lesions. In comparison, stent placement in long FP lesions is associated with superior outcomes to balloon angioplasty, even when multiple stents are required. Procedure success and clinical improvement can be achieved in the majority of patients, but rates of restenosis remain high.

Original languageEnglish (US)
Pages (from-to)34-43
Number of pages10
JournalJournal of Endovascular Therapy
Volume21
Issue number1
DOIs
StatePublished - Feb 1 2014

Fingerprint

Balloon Angioplasty
Stents
nitinol
Angioplasty
Ischemia
Extremities

Keywords

  • Balloon angioplasty
  • Chronic total occlusion
  • Critical limb ischemia
  • Femoropopliteal segment
  • Lesion length
  • Nitinol stent
  • Peripheral artery disease
  • Popliteal artery
  • Restenosis
  • Stenosis
  • Superficial femoral artery

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Armstrong, E. J., Saeed, H., Alvandi, B., Singh, S., Singh, G. D., Yeo, K. K., ... Laird, J. R. (2014). Nitinol self-expanding stents vs. balloon angioplasty for very long femoropopliteal lesions. Journal of Endovascular Therapy, 21(1), 34-43. https://doi.org/10.1583/13-4399MR.1

Nitinol self-expanding stents vs. balloon angioplasty for very long femoropopliteal lesions. / Armstrong, Ehrin J.; Saeed, Haseeb; Alvandi, Bejan; Singh, Satinder; Singh, Gagan D.; Yeo, Khung Keong; Anderson, David; Westin, Gregory G.; Dawson, David L.; Pevec, William C.; Laird, John R.

In: Journal of Endovascular Therapy, Vol. 21, No. 1, 01.02.2014, p. 34-43.

Research output: Contribution to journalArticle

Armstrong, EJ, Saeed, H, Alvandi, B, Singh, S, Singh, GD, Yeo, KK, Anderson, D, Westin, GG, Dawson, DL, Pevec, WC & Laird, JR 2014, 'Nitinol self-expanding stents vs. balloon angioplasty for very long femoropopliteal lesions', Journal of Endovascular Therapy, vol. 21, no. 1, pp. 34-43. https://doi.org/10.1583/13-4399MR.1
Armstrong, Ehrin J. ; Saeed, Haseeb ; Alvandi, Bejan ; Singh, Satinder ; Singh, Gagan D. ; Yeo, Khung Keong ; Anderson, David ; Westin, Gregory G. ; Dawson, David L. ; Pevec, William C. ; Laird, John R. / Nitinol self-expanding stents vs. balloon angioplasty for very long femoropopliteal lesions. In: Journal of Endovascular Therapy. 2014 ; Vol. 21, No. 1. pp. 34-43.
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abstract = "Purpose: To compare the patency rates and clinical outcomes of balloon angioplasty vs. nitinol stent placement for patients with short (≤150 mm) as compared to long (>150 mm) femoropopliteal (FP) occlusive lesions. Methods: Between 2006 and 2011, 254 patients (134 men; mean age 68 years) underwent FP angioplasty. The majority of patients (64{\%}) were treated for critical limb ischemia. One hundred thirty-nine (55{\%}) patients had short FP lesions ≤150 mm, while 115 patients had long FP lesions >150 mm. The mean lesion length was 78±43 mm in the short FP lesion group and 254±58 mm in the long FP lesion group. Duplex ultrasound follow-up with a peak systolic velocity ratio ≥2.0 was used to define restenosis. Results: The overall procedure success rate was 98{\%}. One hundred forty-eight (58{\%}) patients underwent stent placement. The mean number of stents deployed for treatment of short FP lesions was 1.0±0.4 vs. 2.0±0.7 for long FP lesions (p<0.001). The primary patency rate of short FP lesions treated with balloon angioplasty vs. stenting was 66{\%} vs. 63{\%} at 1 year (p=0.7). For long FP lesions, the 1-year primary patency rates of balloon angioplasty vs. stenting were 34{\%} vs. 49{\%} (p=0.006). Balloon angioplasty of long FP lesions was also associated with significantly lower assisted primary and secondary patency compared to stenting (p<0.05 for all comparisons). Sustained clinical improvement was >90{\%} at 30 days but declined to 62{\%} to 75{\%} at 1 year. Conclusion: Balloon angioplasty and stent placement result in similar patency rates and clinical outcomes for shorter to medium-length FP lesions. In comparison, stent placement in long FP lesions is associated with superior outcomes to balloon angioplasty, even when multiple stents are required. Procedure success and clinical improvement can be achieved in the majority of patients, but rates of restenosis remain high.",
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AU - Saeed, Haseeb

AU - Alvandi, Bejan

AU - Singh, Satinder

AU - Singh, Gagan D.

AU - Yeo, Khung Keong

AU - Anderson, David

AU - Westin, Gregory G.

AU - Dawson, David L.

AU - Pevec, William C.

AU - Laird, John R.

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N2 - Purpose: To compare the patency rates and clinical outcomes of balloon angioplasty vs. nitinol stent placement for patients with short (≤150 mm) as compared to long (>150 mm) femoropopliteal (FP) occlusive lesions. Methods: Between 2006 and 2011, 254 patients (134 men; mean age 68 years) underwent FP angioplasty. The majority of patients (64%) were treated for critical limb ischemia. One hundred thirty-nine (55%) patients had short FP lesions ≤150 mm, while 115 patients had long FP lesions >150 mm. The mean lesion length was 78±43 mm in the short FP lesion group and 254±58 mm in the long FP lesion group. Duplex ultrasound follow-up with a peak systolic velocity ratio ≥2.0 was used to define restenosis. Results: The overall procedure success rate was 98%. One hundred forty-eight (58%) patients underwent stent placement. The mean number of stents deployed for treatment of short FP lesions was 1.0±0.4 vs. 2.0±0.7 for long FP lesions (p<0.001). The primary patency rate of short FP lesions treated with balloon angioplasty vs. stenting was 66% vs. 63% at 1 year (p=0.7). For long FP lesions, the 1-year primary patency rates of balloon angioplasty vs. stenting were 34% vs. 49% (p=0.006). Balloon angioplasty of long FP lesions was also associated with significantly lower assisted primary and secondary patency compared to stenting (p<0.05 for all comparisons). Sustained clinical improvement was >90% at 30 days but declined to 62% to 75% at 1 year. Conclusion: Balloon angioplasty and stent placement result in similar patency rates and clinical outcomes for shorter to medium-length FP lesions. In comparison, stent placement in long FP lesions is associated with superior outcomes to balloon angioplasty, even when multiple stents are required. Procedure success and clinical improvement can be achieved in the majority of patients, but rates of restenosis remain high.

AB - Purpose: To compare the patency rates and clinical outcomes of balloon angioplasty vs. nitinol stent placement for patients with short (≤150 mm) as compared to long (>150 mm) femoropopliteal (FP) occlusive lesions. Methods: Between 2006 and 2011, 254 patients (134 men; mean age 68 years) underwent FP angioplasty. The majority of patients (64%) were treated for critical limb ischemia. One hundred thirty-nine (55%) patients had short FP lesions ≤150 mm, while 115 patients had long FP lesions >150 mm. The mean lesion length was 78±43 mm in the short FP lesion group and 254±58 mm in the long FP lesion group. Duplex ultrasound follow-up with a peak systolic velocity ratio ≥2.0 was used to define restenosis. Results: The overall procedure success rate was 98%. One hundred forty-eight (58%) patients underwent stent placement. The mean number of stents deployed for treatment of short FP lesions was 1.0±0.4 vs. 2.0±0.7 for long FP lesions (p<0.001). The primary patency rate of short FP lesions treated with balloon angioplasty vs. stenting was 66% vs. 63% at 1 year (p=0.7). For long FP lesions, the 1-year primary patency rates of balloon angioplasty vs. stenting were 34% vs. 49% (p=0.006). Balloon angioplasty of long FP lesions was also associated with significantly lower assisted primary and secondary patency compared to stenting (p<0.05 for all comparisons). Sustained clinical improvement was >90% at 30 days but declined to 62% to 75% at 1 year. Conclusion: Balloon angioplasty and stent placement result in similar patency rates and clinical outcomes for shorter to medium-length FP lesions. In comparison, stent placement in long FP lesions is associated with superior outcomes to balloon angioplasty, even when multiple stents are required. Procedure success and clinical improvement can be achieved in the majority of patients, but rates of restenosis remain high.

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KW - Chronic total occlusion

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KW - Femoropopliteal segment

KW - Lesion length

KW - Nitinol stent

KW - Peripheral artery disease

KW - Popliteal artery

KW - Restenosis

KW - Stenosis

KW - Superficial femoral artery

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