title: Outcomes of covered versus bare-metal balloon-expandable stents for aortoiliac occlusive disease.
abstract: OBJECTIVE
  Randomized trials and retrospective data suggest that covered balloon-expandable (CBE) stents have better short-term patency compared with balloon-expandable bare-metal stents (BMSs) in the treatment of iliac artery disease. This study evaluated midterm outcomes of BMSs vs CBE stents placed in the common iliac artery (CIA) for aortoiliac occlusive disease.
  
  
  METHODS
  All endovascular interventions for symptomatic peripheral arterial occlusive disease performed at a single institution from 2006 to 2012 were reviewed. Patients undergoing stent placement in the CIA segment were included in the analysis. Demographic data, TransAtlantic Inter-Society Consensus (TASC) classification, stent type, patency, and limb reinterventions were compared.
  
  
  RESULTS
  For treatment of de novo distal aorta or CIA stenosis, 254 procedures were performed in 162 patients. BMSs were used in 190 arteries; CBE stents were used in 64 arteries. There was no difference in age, gender, or TASC classification between the two groups. Mean follow-up was 22 ± 16 months. Primary patency, assisted patency, and secondary patency were significantly better in the BMS group. CIAs treated with covered stents were more likely at 1 year or longer to require repeated intervention (hazard ratio, 2.5; 95% confidence interval, 1.2-5.3; P = .009). TASC classification did not predict need for reintervention in either group. Multivariate analysis revealed dual antiplatelet therapy to be the only other factor to affect patency during long-term follow-up.
  
  
  CONCLUSIONS
  In this study, BMSs had significantly better patency compared with CBE stents for treatment of aortoiliac occlusive disease. A randomized trial comparing patency as well as restenosis rates with long-term follow-up is needed to determine if there is any benefit from use of covered stents in the aortoiliac segment.
authors.affiliation: Division of Vascular/Endovascular Surgery, University of California Davis Medical Center, Sacramento, Calif. Electronic address: dzstorm.md@gmail.com.
authors.forename: Misty D
authors.initials: MD
authors.lastname: Humphries
authors.affiliation: Division of Interventional Cardiology, University of Colorado, Denver, Colo.
authors.forename: Ehrin
authors.initials: E
authors.lastname: Armstrong
authors.affiliation: Division of Vascular/Endovascular Surgery, University of California Davis Medical Center, Sacramento, Calif.
authors.forename: John
authors.initials: J
authors.lastname: Laird
authors.affiliation: Division of Vascular/Endovascular Surgery, University of California Davis Medical Center, Sacramento, Calif.
authors.forename: Jessica
authors.initials: J
authors.lastname: Paz
authors.affiliation: Division of Vascular/Endovascular Surgery, University of California Davis Medical Center, Sacramento, Calif.
authors.forename: William
authors.initials: W
authors.lastname: Pevec
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001018:Aortic Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002140:California; D016009:Chi-Square Distribution; D020099:Coated Materials, Biocompatible; D003251:Constriction, Pathologic; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D015999:Multivariate Analysis; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D020099:Coated Materials, Biocompatible; D008670:Metals; D010975:Platelet Aggregation Inhibitors
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