Interwoven Nitinol Stents versus Drug Eluting Stents in the Femoro-Popliteal Segment: A Propensity Matched Analysis

• Published in: European journal of vascular and endovascular surgery 2019-11, Vol.58 (5), p.719-727
• Main Authors: Saratzis, Athanasios, Rudarakanchana, Nung, Diamantopoulos, Athanasios, Lea, Talia, Corbo, Ben, Gradinariu, George, Katsanos, Konstantinos, Zayed, Hany
• Format: Article
• Language: English
• Subjects: Aged; Alloys - therapeutic use; Angioplasty; Angioplasty - adverse effects; Angioplasty - instrumentation; Angioplasty - methods; Computed Tomography Angiography - methods; Computed Tomography Angiography - statistics & numerical data; Extremities - blood supply; Female; Femoral Artery - pathology; Femoral Artery - surgery; Graft Occlusion, Vascular - diagnosis; Graft Occlusion, Vascular - epidemiology; Graft Occlusion, Vascular - etiology; Humans; Limb Salvage - methods; Male; Outcome and Process Assessment, Health Care; Peripheral arterial disease; Peripheral Arterial Disease - pathology; Peripheral Arterial Disease - physiopathology; Peripheral Arterial Disease - surgery; Plaque, Atherosclerotic - diagnostic imaging; Popliteal Artery - pathology; Popliteal Artery - surgery; Prognosis; Stent; Stents - adverse effects; Stents - classification; Surgery; Vascular Calcification - diagnostic imaging; Vascular Patency
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2019.06.012

BackgroundPercutaneous transluminal angioplasty (PTA) is a common procedure in patients with peripheral arterial disease (PAD) affecting the femoropopliteal segment (F-P). Biomimetic nitinol stents (Supera peripheral stent, SPS) and drug eluting stents (DES) were designed to improve the longevity of F-P PTA; however, their performance has not been compared in a pragmatic setting, taking atherosclerotic plaque characteristics into account. MethodsOverall, 296 consecutive patients (mean age: 73 y, SD: 11 y, 65% male, 68% with chronic limb threatening ischaemia) who underwent F-P PTA using SPS or DES between 2013 and 2018 were identified from a prospectively maintained institutional database. Patient and plaque characteristics, including F-P plaque characterisation based on computed tomography, were collected; 121 case matched pairs were created using a propensity score based on patient and plaque data. ResultsDuring the median two year follow up, 28% of the cohort (32% SPS vs. 24% DES, p = .07) developed target lesion restenosis (TLR) > 50%. Among the 121 case matched pairs of patients, those with SPS vs. DES were not significantly more likely to develop TLR >50% (31% vs. 27%, p = .34), or stent occlusion (13% vs. 12%, p = .85 – secondary patency rate 87% vs. 88%), have a major amputation (10% vs. 6%, p = .16), require re-intervention (14% vs. 9%, p = .12), or die (7% vs.4%, p = .31). Plaque calcification did not predict restenosis or occlusion in either stent group, both in the matched and non matched populations. Multivariable analysis adjusted for patient and plaque characteristics revealed that the main predictors of restenosis >50% at two years were female sex [odds ratio (OR): 2.05, p = .01], hypertension (OR: 2.10, p = .04) and previous F-P occlusion (OR: 1.35, p = .04). ConclusionMedium term results following F-P PTA with either SPS or DES are comparable, regardless of plaque calcification and patient characteristics.