Incidence, anatomical location, and clinical significance of compressions and fractures in infrapopliteal balloon-expandable metal stents.
OBJECTIVE
To investigate the incidence, anatomical location, and clinical impact of fractures and/or compression of infrapopliteal balloon-expandable metal stents implanted for critical limb ischemia (CLI) treatment.


METHODS
This prospective study included 63 CLI patients (45 men; mean age 71.3+/-9.5 years) who had been treated with infrapopliteal angioplasty and stent placement for 191 lesions in 84 limbs. In all, 369 stents (296 stainless steel and 73 cobalt-chromium alloy) were implanted; 239 were placed overlapping in tandem lesions. Mean length of the overall stented segment was 4.4+/-6.3 cm (range 1.6-14.0). Stents were located in the tibioperoneal (n = 34), anterior tibial (n = 195), posterior tibial (n = 63), and peroneal (n = 77) arteries. Follow-up consisted of digital subtraction angiography and infrapopliteal radiography imaging at 2 different angles. Evaluation of stents for the presence of fracture and/or compression was done after digital processing at the highest possible magnification. Stent fractures were defined according to published standards, whereas compression was classified as severe shape alteration and/or collapse of the stent mesh. Angiographic restenosis was based on a 50% threshold.


RESULTS
Mean follow-up was 15+/-11 months (range 6-60). Image analysis detected 1 (0.3%) severe stent fracture (complete separation and misalignment of stent struts) and 11 (3.0%) stent compressions. Infrapopliteal stent fracture and compressions were associated with increased artery restenosis [100% (12/12) versus 47.3% (169/357), p<0.001] and an increased rate of clinical deterioration and clinically-driven reinterventions [41.7% (5/12 limbs) versus 19.4% (14/72 limbs), p = 0.04]. The single fracture and most of the compressions were located in the distal third of the anterior tibial artery.


CONCLUSIONS
Stent fractures and compressions of infrapopliteal balloon-expandable metal stents are infrequent. However, they may be related to increased restenosis.
Karnabatidis
Dimitris
D
Department of Radiology, Patras University Hospital, Rion, Greece. karnaby@med.upatras.gr
Katsanos
Konstantinos
K
Spiliopoulos
Stavros
S
Diamantopoulos
Athanasios
A
Kagadis
George C
GC
Siablis
Dimitris
D
D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D002858:Chromium Alloys; D003251:Constriction, Pathologic; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012008:Recurrence; D013193:Stainless Steel; D015607:Stents; D013314:Stress, Mechanical; D016909:Tibial Arteries / Q000000981:diagnostic imaging; D013997:Time Factors; D017211:Treatment Failure
D002858:Chromium Alloys; D013193:Stainless Steel