Evolution of patency rates of self-expandable bare metal stents for endovascular treatment of femoro-popliteal arterial occlusive disease: Does stent design matter?
OBJECTIVE
To analyse the patency rates of femoro-popliteal stenting with different self-expandable Nitinol stent-designs.


METHODS
Two hundred and twenty-two patients (142 (64%) male; age 72.4 ± 11.6 years) with symptomatic femoro-popliteal peripheral arterial occlusive disease (PAOD) underwent percutaneous transluminal angioplasty (PTA) and stenting with three different Nitinol stents (interwoven IW: n = 70; closed-cell CC: n = 85; open-cell OC: n = 67). One-year post-procedural target lesion revascularization (TLR_12M) rates were investigated with regard to co-morbidities: diabetes (DBM), hyperlipidaemia (HLP), hypertension (RR), coronary artery disease (CAD) and degree of calcification.


RESULTS
Twelve-month follow-up data were available for 60, 69 and 50 patients in the IW, OC and CC groups (179 patients in total). The cumulative patency (IW: 52 (86.7%); OC: 50 (72.5%); CC: 23 (46.0%); P < 0.001) and the TLR_12M rates (IW: 8 (13.3%); OC: 19 (27.5%); CC: 27 (54.0%); P < 0.001) differed significantly, as did the subgroup analyses (DBM: P = 0.05; RR: P = 0.003; HLP: P = 0.005; CAD: P = 0.02; localization: P < 0.001; calcification: P < 0.001), with the best patency for the IW stent and the highest TLR_12M for the CC stent.


CONCLUSIONS
The interwoven stent-design was superior to the standard open- and closed-cell stent-designs in endovascular treatment of femoro-popliteal PAOD in a follow-up period of 12 months.


CONCLUSIONS
• Results of femoro-popliteal stenting are still unsatisfactory. • Comparative studies for currently available different Nitinol stent-designs are lacking. • This is a first comparative study on long-term patency of different Nitinol stent-designs. • Interwoven stent-design leads to improved long-term patency. • Interwoven stent-design leads to lower TLR than other stent-designs.
Institute for Clinical Radiology, Hospitals of the Ludwig-Maximilians-University of Munich, Nussbaumstr. 20, 80336, Munich, Germany.|German Center for Cardiovascular Disease Research (DZHK e. V.), Pettenkoferstr. 8a, 80336, Munich, Germany.
Karla Maria
KM
Treitl
Institute for Clinical Radiology, Hospitals of the Ludwig-Maximilians-University of Munich, Nussbaumstr. 20, 80336, Munich, Germany.
Benedikt
B
Woerner
Institute for Clinical Radiology, Hospitals of the Ludwig-Maximilians-University of Munich, Nussbaumstr. 20, 80336, Munich, Germany.
Regina
R
Schinner
Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospitals of the Ludwig-Maximilians-University of Munich, Munich, Germany.
Michael
M
Czihal
Institute for Clinical Radiology, Hospitals of the Ludwig-Maximilians-University of Munich, Nussbaumstr. 20, 80336, Munich, Germany.
Susan
S
Notohamiprodjo
Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospitals of the Ludwig-Maximilians-University of Munich, Munich, Germany.
Ulrich
U
Hoffmann
Institute for Clinical Radiology, Hospitals of the Ludwig-Maximilians-University of Munich, Nussbaumstr. 20, 80336, Munich, Germany. mtreitl@med.uni-muenchen.de.
Marcus
http://orcid.org/0000-0001-9109-3211
M
Treitl
D000368:Aged; D000497:Alloys / Q000627:therapeutic use; D017130:Angioplasty / Q000295:instrumentation* / Q000379:methods; D000800:Angioplasty, Balloon / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000473:pathology / Q000601:surgery*; D003324:Coronary Artery Disease / Q000503:physiopathology; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D008297:Male; D058729:Peripheral Arterial Disease / Q000473:pathology / Q000601:surgery; D011150:Popliteal Artery / Q000601:surgery*; D011474:Prosthesis Design; D015424:Reperfusion / Q000379:methods; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology
D000497:Alloys; C013616:nitinol
Femoro-popliteal stenting; Interwoven stent; Peripheral artery occlusive disease; Self-expandable Nitinol stent; Stent-design