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Nasr B, Gouailler F, Marret O, Guillou M, Chaillou P, Guyomarc'h B, Maurel B, Gouëffic Y. Treatment of Long Femoropopliteal Lesions With Self-Expanding Interwoven Nitinol Stent: 24 Month Outcomes of the STELLA-SUPERA Trial. J Endovasc Ther 2023; 30:98-105. [PMID: 35114841 DOI: 10.1177/15266028221075227] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The performance of self-expanding interwoven nitinol stent (Supera) in femoropopliteal interventions has been proven through trials with short lesions and with relatively low proportion of occlusions. There is limited evidence of Supera stent in long lesions. The aim of this study was to assess the clinical safety and efficiency of the Supera stent in the treatment of long femoropopliteal lesions (Trans-Atlantic Inter-Society Consensus [TASC] C/D) in patients with symptomatic peripheral arterial disease (PAD). METHODS The STELLA SUPERA (STEnting Long de L'Artère fémorale superficielle par le stent métallique Supera) is a prospective, 2-center, single-arm study. Patients with symptomatic (Rutherford stages 2-6) de novo and TASC C/D lesions of the femoropopliteal segment were treated with Supera stent. The primary endpoint was the primary sustained clinical improvement at 12 months. Follow-up included clinical examination, duplex scan, and biplane X-ray up to 24 months. RESULTS Between December 2016 and October 2018, 48 symptomatic patients with 49 femoropopliteal lesions (TASC D = 32, 65%) were treated. The mean lesion length was 234 ± 123 mm, and 78% were total occlusion. The mean stented lesion length was 273 ± 127 mm. At 12 and 24 months, the primary sustained clinical improvement rate was 87.2% and 79.7%, respectively. The Rutherford category assessment was significantly improved at 24 months compared with baseline (p=0.02). At 24 months, the primary patency and freedom from target lesion revascularization (TLR) rates were 77.9% and 86.9%, respectively. The ankle-brachial pressure index increased from 0.62 ± 0.15 at baseline to 0.93 ± 0.15 at 24 months (p<0.0001). There were no stent fractures at 24 months. CONCLUSION The use of Supera stent in long lesions (TASC C/D) is a safe and effective endovascular alternative. These results reinforce the need for randomized clinical trials to assess the value of interwoven stents for long femoropopliteal lesions.
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Affiliation(s)
- Bahaa Nasr
- Service de Chirurgie Vasculaire, l'institut du Thorax, CHU Nantes, Nantes, France
| | - Flora Gouailler
- Service de Chirurgie Vasculaire, Clinique Océane, Vannes, France
| | - Olivier Marret
- Service de Chirurgie Vasculaire, CH de la Roche sur Yon, La Roche-sur-Yon, France
| | - Marie Guillou
- Service de Chirurgie Vasculaire, l'institut du Thorax, CHU Nantes, Nantes, France
| | - Philippe Chaillou
- Service de Chirurgie Vasculaire, l'institut du Thorax, CHU Nantes, Nantes, France
| | - Béatrice Guyomarc'h
- Service de Chirurgie Vasculaire, l'institut du Thorax, CHU Nantes, Nantes, France
| | - Blandine Maurel
- Service de Chirurgie Vasculaire, l'institut du Thorax, CHU Nantes, Nantes, France.,Laboratoire de Physiopathologie de la Résorption Osseuse, Inserm-UN UMR-957, Nantes, France
| | - Yann Gouëffic
- Laboratoire de Physiopathologie de la Résorption Osseuse, Inserm-UN UMR-957, Nantes, France.,Service de Chirurgie Vasculaire et Endovasculaire, Groupe Hospitalier Paris St Joseph, Paris, France
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Fung V, Chan YC, Cheung GC, Cheng SW. Risk Factor Analysis and Long-Term Outcomes in Patients with Endovascular Revascularization for Intermittent Claudication or Chronic Limb-Threatening Ischemia. Ann Vasc Surg 2023; 89:261-268. [PMID: 36162626 DOI: 10.1016/j.avsg.2022.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The aim of this study is to review long-term outcome and identify risk factors for patients with peripheral arterial disease (PAD) with percutaneous transluminal angioplasty/stent as a primary treatment strategy for intermittent claudication (IC) or chronic limb-threatening ischemia (CLTI). METHODS A retrospective cohort study with data collected prospectively from Clinical Data Analysis and Reporting System, departmental database, and Clinical Management System. All patients who underwent endovascular procedures for PAD between January 2011 and December 2020 were identified. The primary outcomes are overall survival and amputation-free survival. Predictive factors for OS and AFS were determined using Cox Model. RESULTS A total number of 640 patients with PAD (IC, n = 243; CLTI, n = 377) underwent endovascular percutaneous transluminal angioplasty/stenting for PAD from January 2011 to December 2020. Patients with CLTI had a significantly higher 30 days readmission rate (18.8% vs. 6.5%, P < 0.001), emergency reoperation within 30 days (3.4% vs. 0%, P = 0.002), and death within same admission (2.7% vs. 0%, P = 0.008) compared to IC patients. The overall survival and amputation-free survival rates were significantly lower in CLTI patients (P < 0.0001 and P < 0.0001, respectively). On Cox multivariate analysis, CLTI was strongly predictive of all-cause mortality and amputation (hazard ratio [HR] 2.33 and HR 14.92, respectively). In patients with CLTI, chronic kidney disease was an independent predictor of mortality and amputation (HR 1.66 and HR 2.36, respectively). Smoking and ischemic heart disease were also independent predictors of mortality in this subgroup (HR 2.06 and HR 2.43, respectively). CONCLUSIONS Although patients with IC and CLTI both manifest from atherosclerotic occlusive disease of the lower limb arteries, these patients may have different clinical outcomes with significant mortality occurred in both IC and CLTI groups. In patients with IC, the risk of amputation was less than 1% at 5 years following revascularization.
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Affiliation(s)
- Victor Fung
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
| | - Yiu Che Chan
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
| | - Grace C Cheung
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
| | - Stephen W Cheng
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
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Low J, Shih T, Lu E, Derubertis BG, Baril DT. Midterm Results of the Supera Stent for the Treatment of Femoropopliteal Occlusive Disease. Ann Vasc Surg 2022; 86:177-183. [PMID: 35779806 DOI: 10.1016/j.avsg.2022.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/20/2022] [Accepted: 05/18/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Supera (Abbott Vascular, Santa Clara, CA) stent is an interwoven nitinol, shape-memory stent with high strength and flexibility characteristics which are purported to increase resistance to kinking and compression. The purpose of this study was to review single-center outcomes of the use of this stent in the femoropopliteal segment. METHODS We performed a single-center, retrospective analysis of patients who underwent Supera stent placement for femoropopliteal occlusive disease from 2016-2019. Data was collected on patient demographics and procedural details. Follow-up imaging data, including duplex imaging and ankle-brachial indices, and clinical data were abstracted from encounter notes. RESULTS Sixty-two patients with 72 unique Supera stent placements were identified. Mean age was 76 and 69% were male. 56% of patients had severe calcification and 11% had moderate calcification. 48% of lesions were Trans-Atlantic Inter-Society Consensus Document C or D lesions. Primary patency rates at 12, 24, and 36 months were 85%, 82%, and 75%, respectively. Primary patency was not affected significantly by lesion length, degree of calcification, number of outflow vessels, concomitant interventions, or stent size. CONCLUSIONS These results demonstrate sustained primary patency with the Supera stent over a 3-year interval in treatment of patients with femoropopliteal occlusive disease, including in the setting of severely calcified vessels.
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Affiliation(s)
- Josiah Low
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Terri Shih
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Eileen Lu
- Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Brian G Derubertis
- Division of Vascular Surgery, Weill Cornell Medical College, New York, NY
| | - Donald T Baril
- Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
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Gujja K, Purushottam B, Kapur V, Cox‐Alomar PR, Krishnan P. Popliteal Artery Interventions. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Yang M, Shi B, Lubo MA, Yu C, Zhang X, Li T, Zhang X, Wang Y, Zhuang B. Treatment of atherosclerotic femoropopliteal artery disease with Supera interwoven nitinol stent: a real-world study in China. Ann Vasc Surg 2022; 85:183-189. [PMID: 35271965 DOI: 10.1016/j.avsg.2022.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/06/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To analyze the outcomes of Supera stent deployment in Chinese patients with atherosclerotic femoropopliteal artery (FPA) disease in a real-world setting. METHODS This retrospective cohort study collected and analyzed the medical records of 246 consecutive patients who received Supera stents for FPA disease at the China Academy of Chinese Medical Sciences Xiyuan Hospital between February 2017 and December 2019. All study patients underwent balloon angioplasty and were treated with Supera stents (Abbott Vascular, Santa Clara, CA, USA). The primary outcome was the rate of primary patency 12 months after discharge. RESULTS The analyses included 246 consecutive patients and 260 lesions. The mean ± SD age was 73.2±9.9 years and most patients (60.2%) were male. Of the 260 treated lesions, Supera stents were deployed in eight (3.1%) cases after previous stent fracture. Critical limb ischemia was diagnosed in 87.3% of the limbs, and 84 (32.3%) and 83 (31.5%) cases were classified as TransAtlantic Inter-Society Consensus (TASC) C and D, respectively. The majority of the lesions was in situ (80.8%) and located in the superficial femoral artery (45.0%) or the femoropopliteal artery (45.8%). The mean lesion length was 147.7 mm. Nominal deployment (-10% to 10% compression) was the most common deployment scenario (84.1%). The 1-year primary patency rate was 80.6%. Lesions that occurred as restenosis (OR = 3.34, 95% CI: 1.03-10.85, P = 0.045) or in-stent restenosis (OR = 2.88, 95% CI: 1.03-8.07, P = 0.045) were independently associated with occlusion or stenosis after stent deployment. No stent fracture was observed in the study. CONCLUSIONS Our study indicates that the use of Supera stents is feasible for treatment of Chinese patients with FPA disease. The long-term results reveal high primary patency.
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Affiliation(s)
- Miao Yang
- Department of Vascular Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bo Shi
- Department of Vascular Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - M A Lubo
- Department of Vascular Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chunli Yu
- Department of Vascular Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xueyuan Zhang
- Department of Vascular Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tiantian Li
- Department of Vascular Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xuan Zhang
- Department of Vascular Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yujie Wang
- Department of Vascular Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Baixi Zhuang
- Department of Vascular Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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STAHLBERG E, PLANERT M, ANTON S, SIEREN M, WIEDNER M, BARKHAUSEN J, GOLTZ JP. Functional angiograms after stent implantation into the femoropopliteal artery. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.23736/s1824-4777.21.01471-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Supera Stent for Management of Occlusive Popliteal Artery Disease: an Indian Experience. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02370-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abstract
Introduction
Popliteal artery occlusion is common in elderly, smokers, and patients with diabetes, with globally rising incidence. Angioplasty and stenting are common treatment options available to manage lower limb occlusive diseases. As popliteal artery experiences high biomechanical stress, Supera stent is designed to reduce the risk of stent fractures and for better patency across the knee joint.
Aim & Objectives
The aim of this study is to evaluate the Supera stent in the management of popliteal artery occlusive disease. The objectives of this study are (1) to evaluate the efficacy of Supera stent in the management of popliteal artery occlusive disease and (2) to prove it as a relatively safe to use option.
Material & Methods
Patients who underwent stent implantation in popliteal artery were analyzed with regular/serial follow-up. Critical limb ischemia and intermittent claudication patients were included. Medical records, radiographs, and procedural data were examined. The patients were classified according to Trans-Atlantic Inter Society Consensus II criteria. The femoropopliteal lesions which were classified into TASC B and C categories were included in the study. Stents of 5 mm and 5.5 mm diameter and with various lengths were used to treat all the patients.
Results
A total number of patients with tissue loss and rest pain analyzed were eighty-six and all of them were treated by implanting stents in popliteal artery. In 71.4% of cases, the lesions were found in the proximal segment of the artery. In nearly 95% of cases, technical success was achieved with the use of single stent. The primary and assisted primary patency rates at 24 months were found to be 86.04% and 95.34%, respectively. Notwithstanding the stent placement at a region of high biomechanical stress, there was no case of stent fracture. The limb salvage rate was 100%. The patients who died due to unrelated causes within 90 days of procedure were two.
Conclusion
The present study demonstrated that Supera stent is a safe and effective procedure for treating claudication and limb ischemia due to popliteal artery disease.
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Chan YC, Cheng SW, Cheung GC. A midterm analysis of patients who received femoropopliteal helical interwoven nitinol stents. J Vasc Surg 2020; 71:2048-2055. [DOI: 10.1016/j.jvs.2019.08.284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 08/16/2019] [Indexed: 10/25/2022]
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Armstrong EJ, Jeon-Slaughter H, Kahlon RS, Niazi KA, Shammas NW, Banerjee S. Comparative Outcomes of Supera Interwoven Nitinol vs Bare Nitinol Stents for the Treatment of Femoropopliteal Disease: Insights From the XLPAD Registry. J Endovasc Ther 2019; 27:60-65. [PMID: 31686573 DOI: 10.1177/1526602819885652] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To report a propensity score analysis comparing outcomes of the Supera interwoven nitinol stent to bare nitinol stents (BNS) in the femoropopliteal segment. Materials and Methods: A retrospective study was conducted utilizing data extracted from the Excellence in Peripheral Artery Disease (XLPAD) registry (ClinicalTrials.gov identifier NCT01904851) on 871 patients (mean age 65.1 years; 713 men) who underwent femoropopliteal balloon angioplasty with either Supera stent implantation in 118 limbs or other contemporary BNS in 753 limbs between January 2006 and December 2016. All patients in both groups were matched for baseline demographic and clinical characteristics in a 1:1 propensity score matching using the nearest neighbor method to create the 118-patient matched BNS cohort. One-year outcomes included all-cause mortality, target vessel revascularization (TVR), and target limb revascularization (TLR). An additional core laboratory analysis was conducted to measure the deployed length of Supera stents. Results: In unmatched data, the Supera stent group had a numerically lower rate of TVR (7.6% vs 13.4%, p=0.08) and a significantly lower 1-year TLR rate (7.6% vs 16.2%, p=0.02) compared to the BNS group. Both groups had similar 1-year mortality (2.5% vs 2.7%, p=0.9). Kaplan-Meier analysis demonstrated that the Supera group had a significantly lower risk of TVR (p=0.02) and TLR (p=0.002) than the BNS group. After propensity matching, the 1-year TVR estimate was lower for Supera stents (7.6% vs 12.7%, p=0.08) and significantly lower for TLR (7.6% vs 13.6%, p=0.04) than the BNS group. There was no statistically significant association between Supera stent elongation (>10% of the labeled stent length) and 1-year risk of TLR (p=0.6). Conclusion: Supera stent usage in femoropopliteal intervention was associated with reduced risk of 1-year repeat target limb revascularization compared with BNS treatment in both unmatched and matched cohorts.
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Affiliation(s)
- Ehrin J Armstrong
- Division of Cardiology, University of Colorado, Denver, CO, USA.,Rocky Mountain Regional VA Medical Center, Denver, CO, USA
| | - Haekyung Jeon-Slaughter
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,VA North Texas Healthcare System, Dallas, TX, USA
| | - Ravi S Kahlon
- Division of Cardiology, University of Colorado, Denver, CO, USA.,Rocky Mountain Regional VA Medical Center, Denver, CO, USA
| | | | | | - Subhash Banerjee
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,VA North Texas Healthcare System, Dallas, TX, USA
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Real-World Results of Supera Stent Implantation for Popliteal Artery Atherosclerotic Lesions: 3-Year Outcome. Ann Vasc Surg 2019; 62:397-405. [PMID: 31449958 DOI: 10.1016/j.avsg.2019.06.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 06/27/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Reports our experience for the first 50 cases of use of Supera stent for popliteal atherosclerotic lesions treatment. METHODS This prospective single-arm trial enrolled the first 50 limbs (46 patients) treated in our center with a Supera stent for symptomatic atherosclerotic disease of the popliteal artery. Also, a follow-up of 36 months is reported. RESULTS The mean preoperative ankle-brachial index increased from 0.38 ± 0.37 before intervention to 0.63 ± 0.46 postoperatively at 12 months (P = 0.014), 0.66 ± 0.39 at 24 months (P = 0.023), and 0.74 ± 0.46 at 36 months (P = 0.029). Primary patency at 12, 24, and 36 months were 89.6%, 72.3%, and 70.2%, and primary assisted patency was 93.8%, 87.2%, and 85.1%, respectively, by Kaplan-Meier estimates. After 3 years of follow-up, age <75 years (P = 0.034) and Trans-Atlantic Inter-Society Consensus (TASC)-II D lesions (P = 0.041) constituted risk factors for stent occlusion. During the follow-up of the patients, none of them developed stent fracture as evidenced on plain radiographs during follow-up. Implantation defects did not constitute a risk factor for stent restenosis. CONCLUSIONS Based on the results of this study, Supera stent has shown an excellent 3-year patency in this difficult-to-treat anatomic segment. In our experience, younger patients and complex lesions (TASC-II type D) were positive significant predictors for restenosis. In our cohort, post deployment stent conformation did not influence patency. Nevertheless, further investigations, including randomized studies comparing the Supera stent with other stent platforms, drug eluting angioplasty, or atherectomy devices, are mandatory.
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San Norberto EM, Fidalgo- Domingos LA, García-Saiz I, Taylor J, Vaquero C. Endovascular Treatment of Popliteal Artery Occlusion Caused by a Ruptured Supera Interwoven Nitinol Stent. Ann Vasc Surg 2019; 59:308.e9-308.e13. [DOI: 10.1016/j.avsg.2019.02.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/13/2019] [Accepted: 02/21/2019] [Indexed: 10/26/2022]
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Cattaneo G, Bräuner C, Siekmeyer G, Ding A, Bauer S, Wohlschlögel M, Lang L, Hierlemann T, Akimov M, Schlensak C, Schüßler A, Wendel HP, Krajewski S. In vitro investigation of chemical properties and biocompatibility of neurovascular braided implants. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2019; 30:67. [PMID: 31165278 PMCID: PMC7695648 DOI: 10.1007/s10856-019-6270-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 05/06/2019] [Accepted: 05/18/2019] [Indexed: 06/02/2023]
Abstract
Braiding of Nitinol micro wires is an established technology for the manufacturing of fine-meshed neurovascular implants for tortuous vessel geometries. Electropolishing of wires before the braiding process has the potential to improve the in vitro behaviour in terms of thrombogenicity and endothelial cell proliferation. In this study, we present the first in vitro investigation of braided electropolished/blue oxide Nitinol samples in a blood flow loop, showing a significantly lower activation of the coagulation pathway (represented by the TAT III marker) and a tendency towards reduced platelet adhesion. Furthermore, we applied the same surface treatment on flat disks and measured protein adhesion as well as endothelial cell proliferation. We compared our results to non-electropolished samples with a native oxide surface. While platelet deposition was reduced on electropolished/blue oxide surface, a significant increase of endothelial cell seeding was observed. Investigation of inflammatory marker expression in endothelial cells provided divergent results depending on the marker tested, demanding closer investigation. Surface analysis using Auger electron spectroscopy revealed a thin layer mainly consisting of titanium oxynitride or titanium oxide + titanium nitride as a potential cause of the improved biological performance. Translated to the clinical field of intracranial aneurysm treatment, the improved biocompatibility has the potential to increase both safety (low thrombogenicity) and effectiveness (aneurysm neck reconstruction).
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Affiliation(s)
| | | | | | | | | | | | - Lisa Lang
- Department of Thoracic and Cardiovascular Surgery, Clinical Research Laboratory, University Medical Center, Tuebingen, Germany
| | - Teresa Hierlemann
- Department of Thoracic and Cardiovascular Surgery, Clinical Research Laboratory, University Medical Center, Tuebingen, Germany
| | - Maria Akimov
- Department of Thoracic and Cardiovascular Surgery, Clinical Research Laboratory, University Medical Center, Tuebingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, Clinical Research Laboratory, University Medical Center, Tuebingen, Germany
| | | | - Hans-Peter Wendel
- Department of Thoracic and Cardiovascular Surgery, Clinical Research Laboratory, University Medical Center, Tuebingen, Germany
| | - Stefanie Krajewski
- Department of Thoracic and Cardiovascular Surgery, Clinical Research Laboratory, University Medical Center, Tuebingen, Germany
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Mechanical rotational thrombectomy with Rotarex system augmented with drug-eluting balloon angioplasty versus stenting for the treatment of acute thrombotic and critical limb ischaemia in the femoropopliteal segment. Wideochir Inne Tech Maloinwazyjne 2019; 14:311-319. [PMID: 31118999 PMCID: PMC6528111 DOI: 10.5114/wiitm.2018.80006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/23/2018] [Indexed: 12/05/2022] Open
Abstract
Introduction Mechanical thrombectomy is an alternative to local thrombolysis for the treatment of severe ischaemia in the femoropopliteal segment, but stent implantation is usually required after this procedure. The use of drug-eluting balloons (DEBs) may overcome long-term problems associated with stents, but it remains unclear how often such a treatment is technically feasible and efficient. Aim This post hoc single-centre study was aimed at assessment of the feasibility, safety and efficacy of mechanical thrombectomy followed by application of DEBs. Material and methods Fifty-one patients, aged 69.1 ±11.6 years, were managed for acute thrombotic or chronic critical ischaemia in the femoropopliteal segment using the Rotarex device. Following mechanical thrombectomy, on condition that there was no significant residual stenosis or dissection, lesions were managed with paclitaxel-coated DEBs, which was a desired strategy (24 patients). The remaining 25 patients underwent stent implantations, which was regarded as bailout treatment. Final follow-up was scheduled 12 months after the procedure. Results The primary-assisted patency rate after mechanical rotational thrombectomy with additional balloon angioplasty and/or stenting was 97.1% (49 patients). The early mortality rate was 2.0% (1 patient) and the amputation rate was 4.1% (2 patients). There were no late mortalities or limb amputations at 12-month follow-up, but significant restenoses occurred in 13 (27.1%) patients. These restenoses were more frequent in patients who underwent stent implantation (45.5%) than those managed with DEBs (12.5%), and in patients managed for secondary lesions. Conclusions In selected patients mechanical rotational thrombectomy in the femoropopliteal segment followed by application of DEB is a safe, effective and long-lasting method of revascularisation.
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Peker A, Balendran B, Paraskevopoulos I, Krokidis M. Demystifying the Use of Self-Expandable Interwoven Nitinol Stents in Femoropopliteal Peripheral Arterial Disease. Ann Vasc Surg 2019; 59:285-292. [PMID: 31009734 DOI: 10.1016/j.avsg.2019.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/23/2019] [Accepted: 01/30/2019] [Indexed: 12/24/2022]
Abstract
Femoropopliteal atherosclerosis affects a significant percentage of the world population, leading to intermittent claudication and critical limb ischemia. The femoropopliteal segment has a unique set of biomechanical challenges that must be considered and overcome for treatment. The use of stents is a reality and a necessity in peripheral interventions. The success of first-generation femoropopliteal stents was limited by their rigidity and deformability. The standard nitinol stents overcame certain biomechanical challenges because of their superelasticity and thermal shape memory, although stent fracture is still an issue. Therefore, interwoven nitinol stents with helical structure have been developed, borrowing the concept from biliary stents, aiming to provide good flexibility while still maintaining a uniform cell size and significant radial strength. This unique interwoven structure gains it advantage in the femoropopliteal region. The purpose of this review article is to investigate the current published evidence of the use of self-expandable interwoven nitinol stents in femoropopliteal arterial disease and compare them with other endovascular treatment options.
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Affiliation(s)
- Ahmet Peker
- The Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Miltiadis Krokidis
- The Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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Deloose K, Martins I, Neves C, Callaert J. Endovascular treatment for the common femoral artery: is there a challenger to open surgery? THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 60:8-13. [PMID: 30428661 DOI: 10.23736/s0021-9509.18.10787-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Common femoral artery (CFA) atherosclerotic lesions currently remain one of the last limitations for adoption of endovascular repair as the first-line treatment. The bulky, eccentric, heavily calcified character of the CFA plaques, frequent involvement of the femoral bifurcation, easy surgical accessibility and last but not least, favorable long-term outcomes still make CFA disease treatment part of the surgical domain. In the last 5 years, improvement of the endovascular equipment and technical skills of the operators have led to an increase in percutaneous CFA procedures. Especially the vascular mimetic implant Supera Peripheral Stent system (Abbott Vascular), with its extreme crush resistance (if correctly implanted), seems to be an ideal tool to deal with eccentric calcified plaques, crush risk and maintaining access possibilities. The multicentric, prospective, single arm VMI-CFA Trial evaluates the outcome of treatment of symptomatic (Rutherford 2-4) CFA stenotic or occlusive lesions with the Supera Peripheral Stent System. A 6-month cumulative primary patency rate of 100% is noticed, up to 210 days. The cumulative freedom from TLR rate is 100%. Four patients died, not procedure or device related. From a clinical point of view, a tremendous switch from Rutherford 2-4 towards Rutherford 0-1 happened. No procedure nor device related adverse events are noticed. These short-term data confirm the safety and feasibility of an endovascular approach with the Supera stent to the "no-stent zone" CFA. Of course 12- and 24-month data are essential to bring more clarification in this interesting field.
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Affiliation(s)
- Koen Deloose
- Department of Vascular Surgery, A.Z. Sint Blasius Hospital, Dendermonde, Belgium -
| | - Igor Martins
- Department of Vascular Surgery, Hospital Universitario Pedro Ernesto, Rio de Janeiro, Brazil
| | - Caio Neves
- Department of Vascular Surgery, Hospital Universitario Pedro Ernesto, Rio de Janeiro, Brazil
| | - Joren Callaert
- Department of Vascular Surgery, A.Z. Sint Blasius Hospital, Dendermonde, Belgium
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16
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Kurata N, Iida O, Shiraki T, Fujita M, Masuda M, Okamoto S, Ishihara T, Nanto K, Kanda T, Sunaga A, Tsujimura T, Takahara M, Mano T. Impact of Stent-to-Vessel Diameter Ratio on Restenosis in the Superficial Femoral Artery After Endovascular Therapy. Circ J 2018; 82:1412-1417. [DOI: 10.1253/circj.cj-17-0726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Tatsuya Shiraki
- Cardiovascular Center, Kansai Rosai Hospital
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine
| | | | | | | | | | | | | | | | | | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine
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17
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de Boer SW, van den Heuvel DAF, de Vries-Werson DAB, Vos JA, Fioole B, Vroegindeweij D, Elgersma OE, Tutein Nolthenius RP, Heyligers JMM, Bosma GPT, de Leeuw B, Bouwman LH, Böckler D, Dovzhanskiy DI, Vos FWF, Vink TWF, Hooijboer PGA, Hissink RJ, de Vries JPPM. Short-term Results of the RAPID Randomized Trial of the Legflow Paclitaxel-Eluting Balloon With Supera Stenting vs Supera Stenting Alone for the Treatment of Intermediate and Long Superficial Femoral Artery Lesions. J Endovasc Ther 2017; 24:783-792. [DOI: 10.1177/1526602817725062] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sanne W. de Boer
- Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | - Jan Albert Vos
- Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Bram Fioole
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Damnis Vroegindeweij
- Department of Interventional Radiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Otto E. Elgersma
- Department of Interventional Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | | | - Jan M. M. Heyligers
- Department of Vascular Surgery, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands
| | - Gerlof P. T. Bosma
- Department of Interventional Radiology, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands
| | - Bernart de Leeuw
- Department of Interventional Radiology, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Lee H. Bouwman
- Department of Vascular Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Dittmar Böckler
- Clinic for Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany
| | | | - Floris W. F. Vos
- Department of Vascular Surgery, Medical Centre Leeuwarden, the Netherlands
| | - Ted W. F. Vink
- Department of Interventional Radiology, Medical Centre Leeuwarden, the Netherlands
| | | | - Rutger J. Hissink
- Department of Vascular Surgery, Scheper Hospital, Emmen, the Netherlands
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18
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Impact of Implantation Defects on Intermediate Outcome of Supera Stent for Popliteal Artery Stenosis. Ann Vasc Surg 2017; 41:186-195. [DOI: 10.1016/j.avsg.2016.09.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/05/2016] [Accepted: 09/08/2016] [Indexed: 11/24/2022]
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19
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Abstract
Surgical endarterectomy has long been the standard approach for treating atherosclerotic stenosis in the common femoral artery. Its major advantage is the associated long-term patency, which approaches 95% at 5 years. Nevertheless, recent studies have suggested that percutaneous treatment may be a valid alternative to surgery.
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20
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Chan YC, Cheng S. Angioplasty and Stenting of Distal Anastomotic Stenosis of Femoropopliteal Bypass Graft Using Helical Interwoven Nitinol Stents. Int J Angiol 2016; 25:e25-e28. [PMID: 28031646 DOI: 10.1055/s-0034-1370888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Minimally invasive endovascular options of angioplasty and stenting can be used to treat distal anastomotic stenoses in lower limb bypass grafts, but stents near the knee joint may fracture. The nitinol helical interwoven structure of the Supera stents (IDEV Technologies Inc., Houston, TX) has improved flexibility and kink resistance. We report a patient who received salvage angioplasty and Supera stenting of the distal anastomosis of femoropopliteal bypass grafts with good mid-term results. Considering the high radial strength and fracture resistance, these Supera stents may be a good treatment option in salvaging failing bypass grafts.
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Affiliation(s)
- Yiu Che Chan
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Stephen Cheng
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong
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21
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Gujja K, Punukollu G, Kapur V, Krishnan P. Popliteal Artery Interventions. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Karthik Gujja
- The Zena and Michael A. Weiner Cardiovascular Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
| | | | - Vishal Kapur
- The Zena and Michael A. Weiner Cardiovascular Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Prakash Krishnan
- The Zena and Michael A. Weiner Cardiovascular Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
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22
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Myint M, Schouten O, Bourke V, Thomas SD, Lennox AF, Varcoe RL. A Real-World Experience With the Supera Interwoven Nitinol Stent in Femoropopliteal Arteries. J Endovasc Ther 2016; 23:433-41. [DOI: 10.1177/1526602816639543] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the safety and midterm patency of the Supera interwoven nitinol stent in a real-world population and determine deployment and patient-related factors that may predispose to loss of patency. Methods: A retrospective analysis was conducted of 111 consecutive limbs from 97 patients (mean age 75.3 years; 68 men) with severe atherosclerotic disease of the superficial femoral and popliteal arteries that were treated with Supera stents between June 2012 and October 2014. Half the patients had claudication (56%); the remainder had rest pain (19%) and tissue loss (26%). Forty-eight (43%) lesions were chronic total occlusions, and more than half were classified as TransAtlantic Inter-Society Consensus C (22%) or D (30%). Results: All 146 Supera stents (1.32 stents per limb) were deployed successfully, extending over a mean length of 175.5±130.5 mm to treat lesions averaging 151.5±127.1 mm long. At 30 days, Kaplan-Meier estimated freedom from death, target lesion revascularization, and amputation was 97.3%. Primary patency and freedom from clinically driven target lesion revascularization rates were 87.1% and 95.0% at 6 months, respectively, and 78.9% and 87.6% at 12 months, respectively. Four distinct mechanisms for failure were identified in the 13 limbs in which patency was lost; stent intussusception (n=4), compromised inflow or outflow (n=2), gross oversizing (n=1), and neoplastic thrombophilia (n=1); the cause of 5 occlusions could not be identified. Conclusion: In this heterogeneous group that included long and complex atheromatous femoropopliteal lesions, the Supera stent achieved excellent clinical and patency results at 1 year. Further improvement may be achieved through careful patient selection and the avoidance of deployment pitfalls.
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Affiliation(s)
- Michael Myint
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia
| | - Olaf Schouten
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia
- Department of Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Victor Bourke
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia
- The Vascular Institute, Prince of Wales, Sydney, Australia
| | - Shannon D. Thomas
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia
- The Vascular Institute, Prince of Wales, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Andrew F. Lennox
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia
- The Vascular Institute, Prince of Wales, Sydney, Australia
| | - Ramon L. Varcoe
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia
- The Vascular Institute, Prince of Wales, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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23
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Vieira M, Rocha‐Neves J, Paz Dias P, Chaves R, Neto M, Ramos J, Teixeira J. Recanalização subintimal total femoropoplítea após falência de bypass infrapoplíteo: redefinindo estratégias. ANGIOLOGIA E CIRURGIA VASCULAR 2015. [DOI: 10.1016/j.ancv.2015.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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24
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Chan YC, Cheng SW, Cheung GC. Predictors of restenosis in the use of helical interwoven nitinol stents to treat femoropopliteal occlusive disease. J Vasc Surg 2015; 62:1201-9. [DOI: 10.1016/j.jvs.2015.05.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/14/2015] [Indexed: 11/29/2022]
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25
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Georgakarakos E, Xenakis A, Bisdas T, Georgiadis GS, Schoretsanitis N, Antoniou GA, Lazarides M. The shear stess profile of the pivotal fenestrated endograft at the level of the renal branches: A computational study for complex aortic aneurysms. Vascular 2015; 24:368-77. [PMID: 26232391 DOI: 10.1177/1708538115598726] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE This study investigated the impact of the variant angulations on the values and distribution of wall shear stress on the renal branches and the mating vessels of a pivotal fenestrated design. METHODS An idealized endograft model of two renal branches was computationally reconstructed with variable angulations of the left renal branch. These ranged from the 1:30' to 3:30' o'clock position, corresponding from 45° to 105° with increments of 15°. A fluid-structure-interaction analysis was performed to estimate the wall shear stress. RESULTS The proximal part of the renal branch preserved quite constant wall shear stress. The transition zone between its distal end and the renal artery showed the highest values compared to the proximal and middle segments, ranging from 8.9 to 12.4 Pa. The lowest stress values presented at 90° whereas the highest at 45°. The post-mating arterial segment showed constantly low stress values regardless of the pivotal branch angle (6.3 to 6.6 Pa). The 45° configuration showed a distribution of the highest stress posteriorly whereas the 105°-angulation anteriorly. CONCLUSIONS The variant horizontal branch orientation influences the wall shear stress distribution across its length and affects its values only at its transition with the mating vessel. These findings and their potential association with adverse effects deserve further clinical validation.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, "Democritus" Medical School, University Hospital of Alexandroupolis, Greece
| | - Antonios Xenakis
- Fluids Section, School of Mechanical Engineering, National Technical University of Athens, Athens, Greece
| | - Theodosios Bisdas
- Department of Vascular Surgery, St. Franziskus Hospital and University Clinic of Münster, Germany
| | - George S Georgiadis
- Department of Vascular Surgery, "Democritus" Medical School, University Hospital of Alexandroupolis, Greece
| | - Nikolaos Schoretsanitis
- Department of Vascular Surgery, "Democritus" Medical School, University Hospital of Alexandroupolis, Greece
| | - George A Antoniou
- Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | - Miltos Lazarides
- Department of Vascular Surgery, "Democritus" Medical School, University Hospital of Alexandroupolis, Greece
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26
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Bishu K, Armstrong EJ. Supera self-expanding stents for endovascular treatment of femoropopliteal disease: a review of the clinical evidence. Vasc Health Risk Manag 2015. [PMID: 26203255 PMCID: PMC4508067 DOI: 10.2147/vhrm.s70229] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Femoropopliteal lesions account for a significant proportion of endovascular interventions for peripheral artery disease in patients with disabling claudication or chronic limb ischemia. The femoropopliteal artery crosses two joint structures (hip and knee joints) and courses through the muscular adductor canal in the thigh, which places the artery at increased biomechanical stress. There is a critical need for stent platforms with a reduced risk of stent fracture while maintaining patency during long-term follow-up. The Supera peripheral stent system has a braided nickel–titanium alloy stent designed to withstand the unique stressors along the course of the femoropopliteal artery. This design may be associated with improved patency in association with reduced stent fracture rates on short- and medium-term follow-up. Further studies, including randomized controlled studies, comparing the Supera interwoven nickel–titanium alloy stent system with other stent platforms and angioplasty alone are needed.
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Affiliation(s)
- Kalkidan Bishu
- Division of Cardiology, University of Colorado, Aurora, USA ; Denver VA Medical Center, Denver, CO, USA
| | - Ehrin J Armstrong
- Division of Cardiology, University of Colorado, Aurora, USA ; Denver VA Medical Center, Denver, CO, USA
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27
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Brescia AA, Wickers BM, Correa JC, Smeds MR, Jacobs DL. Stenting of femoropopliteal lesions using interwoven nitinol stents. J Vasc Surg 2015; 61:1472-8. [PMID: 25752693 DOI: 10.1016/j.jvs.2015.01.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/16/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Supera stent (Abbott Laboratories, Abbott Park, Ill) has a unique biomimetic design allowing axial and longitudinal flexibility and fracture resistance. The aim of this retrospective study was to assess the midterm patency of Supera stents used to treat patients with superficial femoral and popliteal arterial disease by a single practice. METHODS From April 2010 to December 2011, 53 patients and 59 limbs with symptomatic femoropopliteal lesions underwent angioplasty and stenting with the Supera stent. Five patients had no follow-up and were excluded. Demographics of the patients, radiographic images, morphologic features of the lesions, procedural reports, reinterventions, and follow-up clinical visit notes were reviewed. Primary patency was defined as clinical resolution of symptoms with no secondary interventions. Primary and secondary patency rates at 12, 24, and 36 months were estimated by Kaplan-Meier analysis. RESULTS A total of 48 patients (42 men, six women; 54 limbs; mean age, 64.3 years [range, 51-87]) received Supera stents and had at least one follow-up visit as part of their treatment for femoropopliteal disease. Primary indications for intervention included claudication, rest pain, and tissue loss, at rates of 54% (29 of 54), 26% (14 of 54), and 20% (11 of 54), respectively; 22% of lesions were TransAtlantic Inter-Society Consensus type A or B and 78% were type C or D. Mean lesion length was 24.0 cm (range, 3-51). Mean follow-up was 27.5 months (range, 1-45). The ankle-brachial index increased from 0.58 ± 0.20 preoperatively to 0.77 ± 0.18 postoperatively (P = .00004). Primary, primary assisted, and secondary patency rates at latest follow-up were 79.6%, 88.9%, and 92.3%, respectively. Cumulative primary patency rates by Kaplan-Meier analysis at 12, 24, and 36 months were 85.6%, 83.1%, and 76.7%, respectively. Secondary patency rates by Kaplan-Meier estimates at 12, 24, and 36 months were 93.8%, 93.8%, and 89.3%, respectively. No stent fractures were found at the time of any reinterventions. Long lesions >30 cm (n = 18) showed equivalent patency to lesions of 1 to 15 cm (n = 18) and lesions 15 to 30 cm in length (n = 18). CONCLUSIONS Our midterm results show that Supera stents are durable in treating femoropopliteal lesions, with notably high patency rates in patients with long lesion lengths.
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Affiliation(s)
- Alexander A Brescia
- Division of Vascular Surgery, Department of Surgery, St. Louis University Hospital, St. Louis, Mo
| | - Brian M Wickers
- Division of Vascular Surgery, Department of Surgery, St. Louis University Hospital, St. Louis, Mo
| | - Juan Carlos Correa
- Division of Vascular Surgery, Department of Surgery, St. Louis University Hospital, St. Louis, Mo
| | - Mathew R Smeds
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Donald L Jacobs
- Division of Vascular Surgery, Department of Surgery, St. Louis University Hospital, St. Louis, Mo.
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28
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Panico A, Jafferani A, Shah F, Dieter RS. Advances in Peripheral Arterial Disease Endovascular Revascularization. Cardiol Clin 2015; 33:89-98. [DOI: 10.1016/j.ccl.2014.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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29
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Yiu WK, Conte MS. Primary Stenting in Femoropopliteal Occlusive Disease – What Is the Appropriate Role? –. Circ J 2015; 79:704-11. [DOI: 10.1253/circj.cj-15-0199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Wai-ki Yiu
- Division of Vascular and Endovascular Surgery, University of California
| | - Michael S. Conte
- Division of Vascular and Endovascular Surgery, University of California
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30
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Aghel A, Armstrong EJ. Recent advances in self-expanding stents for use in the superficial femoral and popliteal arteries. Expert Rev Cardiovasc Ther 2014; 12:833-42. [DOI: 10.1586/14779072.2014.918505] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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