Drug-eluting and bare nitinol stents for the treatment of atherosclerotic lesions in the superficial femoral artery: long-term results from the SIROCCO trial.
OBJECTIVE
To review clinical outcomes of patients with chronic limb ischemia and TASC type C lesions treated with sirolimus-eluting versus bare SMART nitinol self-expanding stents.


METHODS
Data were obtained from a randomized, multicenter, double-blinded study conducted in 2 phases. All 93 patients had chronic limb ischemia and superficial femoral artery (SFA) occlusions or stenoses (average lesion length 8.3 cm). In total, 47 patients (31 men; mean age 66.3+/-9.1 years, range 50-84) received the sirolimus-eluting SMART stent and 46 patients (36 men; mean age 65.9 +/-10.8 years, range 38-83) received a bare SMART nitinol stent. Both groups were followed for a mean 24 months.


RESULTS
Both the sirolimus-eluting and the bare SMART stents were effective in revascularizing the diseased SFA and in sustaining freedom from restenosis. For both types of stents, improvements in ankle-brachial indices (ABI) and symptoms of claudication were maintained over 24 months (median 24-month ABI 0.96 for the sirolimus group versus 0.87 for the bare stent group, p>0.05). At 24 months, the restenosis rate in the sirolimus group was 22.9% versus 21.1% in the bare stent group (p>0.05). The cumulative in-stent restenosis rates according to duplex ultrasound were 4.7%, 9.0%, 15.6%, and 21.9%, respectively, at 6, 9, 18, and 24 months; the rates did not differ significantly between the treatment groups. The TLR rate for the sirolimus group was 6% and for the bare stent group 13%; the TVR rates were somewhat higher: 13% and 22%, respectively. Mortality rates did not differ significantly between the groups.


CONCLUSIONS
These data demonstrate that the sirolimus-eluting and the bare SMART stent are effective, safe, and free from restenosis in a majority of patients for up to 24 months. Because the restenosis rate in the bare stent group is unexpectedly low, no significant difference could be found between the sirolimus-eluting and the bare SMART stents.
Duda
Stephan H
SH
Center for Diagnostic Radiology & Minimally Invasive Therapy, The Jewish Hospital Berlin, Heinz-Galinski-Strasse 1, 13347 Berlin, Germany. stephan.duda@t-online.de
Bosiers
Marc
M
Lammer
Johannes
J
Scheinert
Dierk
D
Zeller
Thomas
T
Oliva
Vincent
V
Tielbeek
Alexander
A
Anderson
John
J
Wiesinger
Benjamin
B
Tepe
Gunnar
G
Lansky
Alexandra
A
Jaff
Michael R
MR
Mudde
Catharina
C
Tielemans
Hans
H
Beregi
Jean-Paul
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods*; D000900:Anti-Bacterial Agents; D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D020099:Coated Materials, Biocompatible; D004311:Double-Blind Method; D004337:Drug Carriers; D005260:Female; D005263:Femoral Artery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011475:Prosthesis Failure; D012008:Recurrence; D012449:Safety; D020123:Sirolimus; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
D000497:Alloys; D000900:Anti-Bacterial Agents; D020099:Coated Materials, Biocompatible; D004337:Drug Carriers; C013616:nitinol; D020123:Sirolimus