title: AMS INSIGHT--absorbable metal stent implantation for treatment of below-the-knee critical limb ischemia: 6-month analysis.
abstract: Endoluminal treatment of infrapopliteal artery lesions is a matter of controversy. Bioabsorbable stents are discussed as a means to combine mechanical prevention of vessel recoil with the advantages of long-term perspectives. The possibility of not having a permanent metallic implant could permit the occurrence of positive remodeling with lumen enlargement to compensate for the development of new lesions. The present study was designed to investigate the safety of absorbable metal stents (AMSs) in the infrapopliteal arteries based on 1- and 6-month clinical follow-up and efficacy based on 6-month angiographic patency. One hundred seventeen patients with 149 lesions with chronic limb ischemia (CLI) were randomized to implantation of an AMS (60 patients, 74 lesions) or stand-alone percutaneous transluminal angioplasty (PTA; 57 patients, 75 lesions). Seven PTA-group patients "crossed over" to AMS stenting. The study population consisted of patients with symptomatic CLI (Rutherford categories 4 and 5) and de novo stenotic (>50%) or occlusive atherosclerotic disease of the infrapopliteal arteries who presented with a reference diameter of between 3.0 and 3.5 mm and a lesion length of <15 mm. The primary safety endpoint was defined as absence of major amputation and/or death within 30 days after index intervention and the primary efficacy endpoint was the 6-month angiographic patency rate as confirmed by core-lab quantitative vessel analysis. The 30-day complication rate was 5.3% (3/57) and 5.0% (3/60) in patients randomized for PTA alone and PTA followed by AMS implantation, respectively. On an intention-to-treat basis, the 6-month angiographic patency rate for lesions treated with AMS (31.8%) was significantly lower (p = 0.013) than the rate for those treated with PTA (58.0%). Although the present study indicates that the AMS technology can be safely applied, it did not demonstrate efficacy in long-term patency over standard PTA in the infrapopliteal vessels.
authors.affiliation: Department of Vascular Surgery, AZ St-Blasius, Kroonveldlaan 50, 9200, Dendermonde, Belgium. marc.bosiers@telenet.be
authors.forename: Marc
authors.initials: M
authors.lastname: Bosiers
authors.forename: Patrick
authors.initials: P
authors.lastname: Peeters
authors.forename: Olivier
authors.initials: O
authors.lastname: D'Archambeau
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hendriks
authors.forename: Ernst
authors.initials: E
authors.lastname: Pilger
authors.forename: Christoph
authors.initials: C
authors.lastname: Düber
authors.forename: Thomas
authors.initials: T
authors.lastname: Zeller
authors.forename: Andreas
authors.initials: A
authors.lastname: Gussmann
authors.forename: Paul N M
authors.initials: PN
authors.lastname: Lohle
authors.forename: Erich
authors.initials: E
authors.lastname: Minar
authors.forename: Dierk
authors.initials: D
authors.lastname: Scheinert
authors.forename: Klaus
authors.initials: K
authors.lastname: Hausegger
authors.forename: Karl-Ludwig
authors.initials: KL
authors.lastname: Schulte
authors.forename: Jürgen
authors.initials: J
authors.lastname: Verbist
authors.forename: Koen
authors.initials: K
authors.lastname: Deloose
authors.forename: J
authors.initials: J
authors.lastname: Lammer
mesh_terms: D020341:Absorbable Implants; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply* / Q000000981:diagnostic imaging; D008297:Male; D008670:Metals; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D011446:Prospective Studies; D016879:Salvage Therapy; D018709:Statistics, Nonparametric; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D008670:Metals