Self-expanding nitinol stents for treatment of infragenicular arteries following unsuccessful balloon angioplasty

• Published in: European radiology 2007-08, Vol.17 (8), p.2088-2095
• Main Authors: Tepe, Gunnar, Zeller, Thomas, Heller, Stephan, Wiskirchen, Jakub, Fischmann, Arne, Coerper, Stephan, Balletshofer, Bernd, Beckert, Stefan, Claussen, Claus D
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Alloys; Angioplasty; Angioplasty, Balloon; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - therapy; Arteries; Balloon treatment; Calcification; Feasibility; Feasibility Studies; Female; Flow resistance; Humans; Hyperplasia; Implantation; Implants; Intermetallic compounds; Leg - blood supply; Lesions; Male; Middle Aged; Nickel titanides; Peripheral Vascular Diseases - diagnostic imaging; Peripheral Vascular Diseases - therapy; Prospective Studies; Radiography, Interventional; Restenosis; Sheaths; Stents; Surgical implants; Thrombosis; Treatment Outcome; Ultrasonography, Interventional; Vascular Patency - physiology; Veins & arteries
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-006-0526-5

The feasibility of self-expanding nitinol stents for treatment of infragenicular arteries following unsuccessful balloon angioplasty was assessed. Options for lower limb percutaneous revascularization are limited, especially for complex vessel obstruction. Depending on the lesion and the experience of the interventionalist, the failure rate of balloon angioplasty (PTA) ranges between 10 and 40%. Until recently, no self-expanding stent for the use in the infragenicular arteries was available. This is the first report of the results for 18 consecutive patients who received 4F sheath compatible self-expanding nitinol stents following unsuccessful PTA or early restenosis. Twenty-four stents were implanted in 21 lesions for various indications residual stenosis >50% due to heavy calcification, flow-limiting dissection, occluding thrombus resistant to thrombolyis, thrombaspiration, and PTA, and early restenosis after previous PTA. Stent implantation was feasible in all cases. No complications occurred. After the stent implantation, all primarily unsuccessful interventions could be transformed into successful procedures with no residual stenosis >30% in any case. After 6 +/- 2 months, two of the 18 patients died, and 14 of the 16 remaining patients improved clinically. At follow-up, the patency could be assessed in 14 stented arteries. Three stents were occluded, one stent showed some neointimal hyperplasia (50-70% restenosis), the remaining ten stents showed no restenosis (0-30%). The use of self-expanding nitinol stents in tibioperoneal and popliteal arteries is a safe and feasible option for the treatment of unsuccessful PTA. The 6-months patency is high.