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Rammos C, Zeller T, Piorkowski M, Deloose K, Hertting K, Sesselmann V, Tepe G, Gaines P, Lichtenberg M. The BioMimics 3D Helical Centreline Nitinol Stent in Chronic Limb Threatening Ischaemia and Complex Lesions: Three Year Outcomes of the MIMICS-3D Registry. Eur J Vasc Endovasc Surg 2024; 67:923-932. [PMID: 38447693 DOI: 10.1016/j.ejvs.2024.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 02/01/2024] [Accepted: 02/29/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE There is a need for improved outcomes in the endovascular treatment of patients suffering from chronic limb threatening ischaemia (CLTI), highly calcified lesions, and chronic total occlusions (CTOs). The helical centreline self expanding BioMimics 3D stent might be particularly useful in these high risk subsets, combining flexibility and fracture resistance with radial strength. Herein, the performance of the BioMimics 3D stent was assessed in these high risk subsets. METHODS MIMICS-3D is a prospective, multicentre, European real world registry. This was a post hoc analysis, comparing patients with CLTI vs. intermittent claudication (IC), lesions with bilateral calcification vs. those without (peripheral arterial calcium scoring system [PACSS] 3,4 vs. PACSS 0 - 2), and CTO vs. no CTO. Propensity score matching was performed to reduce the impact of baseline variables. The 36 month endpoints were clinically driven target lesion revascularisation (CD-TLR), death, major target limb amputation, and stent patency. RESULTS A total of 507 patients were enrolled. At 36 months, patients with CLTI had lower freedom from major amputation than patients with IC (92.6% vs. 100%, p < .001). In terms of primary patency, patients with CTO had lower patency rates than those without (63.9% vs. 77.8%, p = .003), but the difference reduced after propensity score matching (70.5% vs. 76.8%, p = .43). Primary patency was not impaired for patients with PACSS 3,4 or patients with CLTI. Freedom from CD-TLR was not significantly different among the groups and was 73.8% for CLTI vs. 78.9% for IC (p = .15), 77.6% for PACSS 3,4 vs. 78.7% for PACSS 0 - 2 (p = .55), and 75.6% for CTO vs. 81.0% for no CTO (p = .11). CONCLUSIONS The outcome of the MIMICS-3D registry suggests that the BioMimics 3D stent is effective in the endovascular treatment of complex femoropopliteal lesions and in CLTI. Future randomised controlled trials should confirm its non-inferiority or superiority compared with existing alternatives.
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Affiliation(s)
- Christos Rammos
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre Essen, University Hospital Essen, Germany.
| | - Thomas Zeller
- Universitätsklinikum Freiburg Herzzentrum, Bad Krozingen, Germany
| | | | - Koen Deloose
- Department of Vascular Surgery, AZ Sint-Blasius Dendermonde, Dendermonde, Belgium
| | - Klaus Hertting
- Department of Cardiology and Angiology, Krankenhaus Buchholz und Winsen GmbH, Buchholz, Germany
| | - Volker Sesselmann
- Department of Angiology, SRH Zentralklinikum Suhl GmbH, Suhl, Germany
| | - Gunnar Tepe
- Department of Diagnostic and Interventional Radiology, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Peter Gaines
- Vascular Institute, Sheffield Hallam University, Sheffield, UK
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Li M, Tu H, Yan Y, Guo Z, Zhu H, Niu J, Yin M. Meta-analysis of outcomes from drug-eluting stent implantation in femoropopliteal arteries. PLoS One 2023; 18:e0291466. [PMID: 37733656 PMCID: PMC10513203 DOI: 10.1371/journal.pone.0291466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE In recent years, studies of drug-eluting stent (DES) for femoropopliteal artery diseases (FPADs) have been gradually published. To explore whether this type of stent is superior to the traditional bare metal stent (BMS), we performed this study. METHODS A systematic search for randomized controlled trials (RCTs) in Excerpta Medica Database (Embase), PubMed, Web of Science (WOS), and Cochrane Library was performed on November 29, 2022. We innovatively adopted the hazard ratio (HR), the most appropriate indicator, as a measure of the outcomes that fall under the category of time-to-event data. The HRs was extracted directly or indirectly. Then, the meta-analyses using random effects model were performed. The bias risks of included papers were assessed by the Cochrane Risk of Bias 2.0 tool. This study was registered on the PROSPER platform (CRD42023391944) and not funded. RESULTS Seven RCTs involving 1,889 participants were found. After pooled analyses, we obtained results without propensity on each of the following 3 outcomes of interest: in-stent restenosis (ISR) -free survival, primary patency (PP) survival, and target lesion revascularization (TLR) -free survival (P >0.05, respectively). Because the results of pooled analyses of the other two outcomes of interest (all-cause death free survival and clinical benefit survival) had high heterogeneity both, they were not accepted by us. CONCLUSION For FPADs, the DES has not yet demonstrated superiority or inferiority to BMS, in the ability to maintain PP, avoid ISR and TLR.
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Affiliation(s)
- Mingxuan Li
- Beijing Fengtai You’anmen Hospital, Beijing, China
| | - Haixia Tu
- Beijing Fengtai You’anmen Hospital, Beijing, China
| | - Yu Yan
- Beijing Fengtai You’anmen Hospital, Beijing, China
| | - Zhen Guo
- Beijing Fengtai You’anmen Hospital, Beijing, China
| | - Haitao Zhu
- Beijing Fengtai You’anmen Hospital, Beijing, China
| | | | - Mengchen Yin
- Beijing Fengtai You’anmen Hospital, Beijing, China
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Fong KY, Xin L, Ng J, Loh SEK, Ng JJ, Choong AMTL. A systematic review and meta-analysis of sirolimus-eluting stents for treatment of below-the-knee arterial disease. J Vasc Surg 2023; 77:1264-1273.e3. [PMID: 36183989 DOI: 10.1016/j.jvs.2022.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/29/2022] [Accepted: 09/19/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE We performed a systematic review and meta-analysis to analyze the efficacy and safety of sirolimus-eluting stents (SESs) in the treatment of below-the-knee (BTK) arterial disease. METHODS An electronic literature search was conducted from inception to July 24, 2021. Retrospective, prospective, and randomized studies that had used SESs to treat BTK arterial disease and had reported the primary patency, technical success, target lesion revascularization, and/or mortality were included. Meta-analyses of the proportions were conducted to derive pooled summary statistics of the outcomes. Where Kaplan-Meier curves were provided for primary patency, a meta-analysis of the individual patient data was conducted via a graphic reconstruction tool to estimate primary patency at various follow-up points. For studies comparing SESs and bare metal stents (BMSs), a two-stage meta-analysis was performed to compare the 6-month primary patency of SESs vs BMSs. RESULTS Ten studies across 13 publications, including 995 patients, were retrieved for analysis. In the meta-analysis of proportions, across six studies (n = 339 patients), the pooled 6-month primary patency was 87.3% (95% confidence interval [CI], 81.6%-92.1%). Across seven studies (n = 283 patients), the pooled 6-month mortality was 5.4% (95% CI, 1.4%-11.2%). An individual patient data analysis of three studies (n = 282 patients) yielded a primary patency rate of 95.2% (95% CI, 92.7%-97.8%), 82.8% (95% CI, 78.3%-87.6%), 79.8% (95% CI, 75.0%-85.0%), and 79.8% (95% CI, 75.0%-85.0%) at 6, 12, 18, and 24 months, respectively. The 12-month target lesion revascularization rate across four studies (n = 324 patients) was 9.6% (95% CI, 6.4%-13.4%). In the two-stage meta-analysis of 6-month primary patency across three studies (n = 168 patients), the use of SESs was significantly favored over BMSs (risk ratio, 1.28; 95% CI, 1.12-1.46; P < .001). CONCLUSIONS The overall evidence suggests that the use of SESs appears to be safe and offers favorable outcomes for BTK arterial disease compared with BMSs.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
| | - Liu Xin
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Magdalen College, University of Oxford, Oxford, UK
| | - Josiah Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
| | - Stanley E K Loh
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Diagnostic Imaging, National University Health System, Singapore
| | - Jun Jie Ng
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Vascular and Endovascular Surgery, National University Heart Centre, Singapore
| | - Andrew M T L Choong
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Vascular and Endovascular Surgery, National University Heart Centre, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore.
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Zhao S, Li L, Cui K. Network Analysis of Endovascular Treatment Strategies for Femoropopliteal Arterial Occlusive Disease. J Endovasc Ther 2022:15266028221090434. [PMID: 35392691 DOI: 10.1177/15266028221090434] [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: 02/05/2023]
Abstract
PURPOSE Endovascular treatment of femoropopliteal arterial diseases remains controversial. We conducted a Bayesian network meta-analysis of randomized controlled trials aiming to investigate the efficacy differences between paclitaxel- or sirolimus-eluting stents, covered stents, drug-coated balloons, bare metal stents, and percutaneous transluminal angioplasty. METHOD MEDLINE, Embase, Ovid, and other relevant online material were searched up to October 21, 2020. Primary endpoints were primary patency and target lesion revascularization at 6, 12, and more than 24 months. RESULTS Thirty-eight eligible trials included 6026 patients. In terms of primary patency, drug eluting stents were ranked as the most effective treatment based on the surface under the cumulative ranking curve values at 6 (80.6), 12 (78.4), and more than 24 months (96.5) of follow-ups. In terms of target lesion revascularization, drug eluting stents were ranked as the most effective treatment based on the surface under the cumulative ranking curve values at 6 (90.3), 12 (71.3), and more than 24 months (82.1) of follow-ups. Covered stents and bare metal stents had higher ranks in target lesion revascularization than those in primary patency. Sirolimus stents had a higher rank than paclitaxel stents. CONCLUSION Drug eluting stents showed encouraging results in primary patency rates and freedom from target lesion revascularization at all phases of follow-up for femoropopliteal arterial diseases. Sirolimus stents appear to be more effective in femoropopliteal segment than paclitaxel stent.
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Affiliation(s)
- Shenyu Zhao
- Department of Cardiovascular Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Lingzhi Li
- Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Kaijun Cui
- Department of Cardiovascular Medicine, West China Hospital of Sichuan University, Chengdu, China
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Colombo M, Bologna M, Garbey M, Berceli S, He Y, Rodriguez Matas JF, Migliavacca F, Chiastra C. Computing patient-specific hemodynamics in stented femoral artery models obtained from computed tomography using a validated 3D reconstruction method. Med Eng Phys 2020; 75:23-35. [DOI: 10.1016/j.medengphy.2019.10.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 09/05/2019] [Accepted: 10/14/2019] [Indexed: 12/30/2022]
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Restenosis Prevention With Drug Eluting or Covered Stents in Femoropopliteal Arterial Occlusive Disease: Evidence From a Comprehensive Network Meta-analysis. Eur J Vasc Endovasc Surg 2019; 58:61-74. [PMID: 31202582 DOI: 10.1016/j.ejvs.2018.12.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 12/20/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND/OBJECTIVE Endovascular interventions for femoropopliteal (FP) arterial diseases are limited by the development of restenosis. Current drug coated devices are capable of preventing restenosis by releasing antiproliferative agents to the vessel wall. However, default strategies for the treatment of FP diseases remain controversial. The aim of this study was to investigate the efficacy differences between drug eluting stents (DES), covered stents (CS), and other commonly used endovascular treatments in FP lesions, including drug coated balloons (DCBs), bare metal stents (BMS), and percutaneous transluminal angioplasty (PTA). METHODS A comprehensive network meta-analysis was conducted using data from relevant randomised control trials published up to 16 December 2018. Primary patency and target lesion revascularisation (TLR) at 12 months were set as the primary and secondary end points, respectively. RESULTS Twenty-eight eligible trials including 4728 patients were selected. DES was ranked as the most effective treatment in the multidimensional analysis of primary patency; however, there was no significant difference in the efficacy of DES and that of CS, DCB, and BMS. However, in short lesions (<10 cm), DES was significantly more effective than DCB (odds ratio 0.35; 95% confidence interval 0.15-0.83). Primary patency at 12 months was significantly lower with PTA. In terms of preventing TLR, DCB was ranked first, followed by DES, CS, BMS, and PTA. TLR was significantly higher with PTA than with other treatment strategies. CONCLUSION The findings of this network meta-analysis suggest that this is not the appropriate time to identify the best endovascular treatment strategy for the FP segment. DES is effective in maintaining mid-term patency, especially in short lesions, whereas DCB seems more suitable for clinical use.
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Secemsky EA, Armstrong EJ. Femoropopliteal Stent Implantation. Circ Cardiovasc Interv 2018; 11:e007134. [PMID: 30354788 DOI: 10.1161/circinterventions.118.007134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eric A Secemsky
- Department of Medicine, Smith Center for Outcomes Research in Cardiology (E.A.S.).,Division of Cardiology, Department of Medicine (E.A.S.), Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA (E.A.S.)
| | - Ehrin J Armstrong
- University of Colorado School of Medicine, Aurora (E.J.A.).,Veterans Affairs Eastern Colorado Health Care System, Denver (E.J.A.).,Denver VA Medical Center, CO (E.J.A.)
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Katsogridakis E, Ballance L, Cawley O, Antoniou GA. Drug-eluting stents for the treatment of complex femoro-popliteal disease: a systematic review and meta-analysis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 63:299-307. [PMID: 30168308 DOI: 10.23736/s0021-9509.18.10614-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Endovascular methods have emerged as an appealing alternative to bypass for the treatment of patients not suitable for surgery. Drug eluting stents (DES) have been developed to address the limitations of angioplasty and stenting. There is a paucity of data in the literature on their performance for the treatment of patients with long femoro- popliteal segment lesions. We aimed to analyse the evidence supporting the use of DES in patients with complex femoro-popliteal disease. EVIDENCE ACQUISITION A systematic review and meta-analysis was conducted according to the recommendations of the Preferred Reporting Items for Systematic reviews and Meta- Analyses (PRISMA) statement. EVIDENCE SYNTHESIS A total of 1255 potentially relevant articles were initially selected. After reviewing at title or abstract level, 22 articles were read in full and 10 were included. These studies reported on the use of DES for 1539 patients. In all studies the DES that was employed was a paclitaxel-eluting stent (Zilver PTX, Cook Medical). Average lesion length ranged from 114mm to 400mm. The pooled technical success rate was 0.964 (95% confidence interval [CI]: 0.936 - 0.980). The pooled estimate of limb loss at 12 months was 0.019 (95% CI: 0.012 - 0.030), stent fracture at 12 months 0.035 (95% CI: 0.007 - 0.155), primary patency at 12 months 0.705 (95% CI: 0.576 - 0.807) and secondary patency at 12 months 0.898 (95% CI: 0.815 - 0.946). CONCLUSIONS The short-term outcomes of DES for TASC C & D femoro-popliteal lesions are encouraging. Caution is advised in extrapolating the results of the included studies due to the large heterogeneity and lack of reporting of subgroup specific outcomes.
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Affiliation(s)
- Emmanuel Katsogridakis
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK - .,Academic Surgery Unit, University Hospital of South Manchester, Manchester, UK -
| | - Laura Ballance
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Oliver Cawley
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
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