Five-year outcomes of self-expanding nitinol stent implantation for chronic total occlusion of the superficial femoral and proximal popliteal artery

• Published in: Catheterization and cardiovascular interventions 2013-09, Vol.82 (3), p.E251-E256
• Main Authors: Sakamoto, Yasunari, Hirano, Keisuke, Iida, Osamu, Soga, Yoshimitsu, Suzuki, Kenji, Muramatsu, Toshiya, Tsukahara, Reiko
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Alloys; Amputation; Angioplasty, Balloon - adverse effects; Angioplasty, Balloon - instrumentation; Arterial Occlusive Diseases - diagnosis; Arterial Occlusive Diseases - physiopathology; Arterial Occlusive Diseases - therapy; Chronic Disease; Constriction, Pathologic; endovascular therapy; Female; Femoral Artery - physiopathology; Humans; Japan; Kaplan-Meier Estimate; Limb Salvage; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Popliteal Artery - physiopathology; Prosthesis Design; PVD-peripheral vascular disease; Recurrence; Retrospective Studies; Risk Factors; self-expandable nitinol stent; Sex Factors; Stents; Time Factors; Treatment Outcome; Vascular Patency
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.24935

Objective To investigate the 5‐year patency rates and predictors of restenosis after self‐expanding nitinol stent implantation for chronic total occlusion (CTO) in superficial femoral and proximal popliteal artery (SFPA) lesions. Background Outcomes and long‐term patency rates after self‐expanding nitinol stent for CTO in the SFPA lesions have not been clarified. Methods From January 2004 to December 2009, 861 serial arteriosclerosis obliterans patients, 1,017 limbs, underwent endovascular therapy with implantation of a self‐expanding nitinol stent for SFPA lesions at four institutions in Japan. Of the cohort, 352 patients, 383 limbs, had self‐expanding nitinol stents implanted for CTOs in the SFPA and were followed for 5 years. We retrospectively investigated patency rate and multivariate predictors associated with restenosis. Results Mean age was 72 ± 9 years and 31% were female patients. In total, 58% of the patients had diabetes mellitus and 25% were patients with critical limb ischemia. Occluded length was 194 ± 89 mm, mean total stent length was 198 ± 7 mm, and mean stent diameter was 7.1 ± 0.9 mm. Five‐year primary and secondary patency rates were 51.8 and 79.5%, respectively, and the rates of freedom from bypass surgery, major or minor amputation, and all‐cause death were 96.1, 96.2, and 78.4%, respectively. Female gender (odds ratio, 1.95; P = 0.0051) and mean stent diameter (odds ratio, 0.77; P = 0.0324) were factors strongly associated with restenosis. Conclusions Women and patients requiring small stents failed to maintain primary patency when treated with self‐expanding nitinol stents for CTO lesions in the SFPA. Although primary patency was low, the secondary patency rate was acceptable. © 2013 Wiley Periodicals, Inc.