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Keiser C, Maleckis K, Struczewska P, Jadidi M, MacTaggart J, Kamenskiy A. A method of assessing peripheral stent abrasiveness under cyclic deformations experienced during limb movement. Acta Biomater 2022; 153:331-341. [PMID: 36162765 PMCID: PMC9810438 DOI: 10.1016/j.actbio.2022.09.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 01/07/2023]
Abstract
Poor outcomes of peripheral arterial disease stenting are often attributed to the inability of stents to accommodate the complex biomechanics of the flexed lower limb. Abrasion damage caused by rubbing of the stent against the artery wall during limb movement plays a significant role in reconstruction failure but has not been characterized. Our goals were to develop a method of assessing the abrasiveness of peripheral nitinol stents and apply it to several commercial devices. Misago, AbsolutePro, Innova, Zilver, SmartControl, SmartFlex, and Supera stents were deployed inside electrospun nanofibrillar tubes with femoropopliteal artery-mimicking mechanical properties and subjected to cyclic axial compression (25%), bending (90°), and torsion (26°/cm) equivalent to five life-years of severe limb flexions. Abrasion was assessed using an abrasion damage score (ADS, range 1-7) for each deformation mode. Misago produced the least abrasion and no stent fractures (ADS 3). Innova caused small abrasion under compression and torsion but large damage under bending (ADS 7). Supera performed well under bending and compression but caused damage under torsion (ADS 8). AbsolutePro produced significant abrasion under bending and compression but less damage under torsion (ADS 12). Zilver fractured under all three deformations and severely abraded the tube under bending and compression (ADS 15). SmartControl and SmartFlex fractured under all three deformations and produced significant abrasion due to strut penetration (ADS 20 and 21). ADS strongly correlated with clinical 12-month primary patency and target lesion revascularization rates, and the described method of assessing peripheral stent abrasiveness can guide device selection and development. STATEMENT OF SIGNIFICANCE: Poor outcomes of peripheral arterial disease stenting are related to the inability of stents to accommodate the complex biomechanics of the flexed lower limb. Abrasion damage caused by rubbing of the stent against the artery wall during limb movement plays a significant role in reconstruction failure but has not been characterized. Our study presents the first attempt at assessing peripheral stent abrasiveness, and the proposed method is applied to compare the abrasion damage caused by Misago, AbsolutePro, Innova, Zilver, SmartControl, SmartFlex, and Supera peripheral stents using artery-mimicking synthetic tubes and cyclic deformations equivalent to five life-years of severe limb flexions. The abrasion damage caused by stents strongly correlates with their clinical 12-month primary patency and target lesion revascularization rates, and the described methodology can be used as a cost-effective and controlled way of assessing stent performance, which can guide device selection and development.
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Affiliation(s)
- Courtney Keiser
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Kaspars Maleckis
- Department of Biomechanics, University of Nebraska Omaha, Biomechanics Research Building, Omaha, NE, United States
| | - Pauline Struczewska
- Department of Biomechanics, University of Nebraska Omaha, Biomechanics Research Building, Omaha, NE, United States
| | - Majid Jadidi
- Department of Biomechanics, University of Nebraska Omaha, Biomechanics Research Building, Omaha, NE, United States
| | - Jason MacTaggart
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - Alexey Kamenskiy
- Department of Biomechanics, University of Nebraska Omaha, Biomechanics Research Building, Omaha, NE, United States,Corresponding author. (A. Kamenskiy)
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Marques L, Hopf-Jensen S, Preiss M, Mueller-Huelsbeck S. An Update on Drug-eluting Technology in Peripheral Arteries to Treat Peripheral Arterial Disease. Heart Int 2021; 15:73-78. [DOI: 10.17925/hi.2021.15.2.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/03/2021] [Indexed: 11/24/2022] Open
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Guo J, Guo L, Cui S, Dardik A, Liu Y, Tong Z, Gu Y. A Retrospective Comparative Study of Twelve-Month Clinical Outcomes for Drug-Coating Balloon Angioplasty and Stent Implantation in Treating Patients with Popliteal Obstructive Lesions. Cardiovasc Intervent Radiol 2020; 44:361-367. [PMID: 33249531 DOI: 10.1007/s00270-020-02557-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/05/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Despite increased interest in treating superficial femoral and popliteal arteries with endovascular technology, there is little data regarding comparative results of different treatment modalities in the popliteal artery. It was hypothesized that to improve clinical outcomes in this segment, drug-coating balloon (DCB) angioplasty would not be inferior to stent implantation. METHODS The records of consecutive Chinese patients with popliteal lesions who were treated with DCB or stenting between June 2016 and February 2017 were retrospectively reviewed. The preoperative demographic, lesion characteristics and postoperative outcomes were compared and statistically analyzed. All patients were divided into different subgroups according to the degree of calcium or degree of ischemia. RESULTS One hundred two consecutive patients with popliteal lesions were treated with DCB or stenting and 95 (93.1%) completed a follow-up. Critical limb ischemia was present in 70.5% and occlusions were present in 61.1% of patients. DCB angioplasty was performed on 43 patients and angioplasty with primary stenting was performed on 52 patients. There was no difference in twelve-month primary patency (79.1% vs 82.7%; P = 0.687), secondary patency (95.3% vs 94.2%; P = 0.808) and amputation-free survival (93.0% vs 94.2%; P = 0.825) between the DCB group and stent groups. In patients with severe calcium, the twelve-month primary patency (61.1% vs. 79.2%; P = 0.239) and amputation-free survival (83.3% vs 87.5%; P = 0.739) did not differ between the DCB and stent groups. CONCLUSIONS This study demonstrates that DCB treatment in Chinese patients with popliteal atherosclerotic occlusive lesions can be associated with similar twelve-month patency and amputation-free survival compared to stenting, even in patients with severe calcification. LEVEL OF EVIDENCE Level 3a, Non-randomized follow-up study.
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Affiliation(s)
- Jianming Guo
- Department of Vascular Surgery, Institute of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lianrui Guo
- Department of Vascular Surgery, Institute of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Shijun Cui
- Department of Vascular Surgery, Institute of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Alan Dardik
- Section of Vascular Surgery, Vascular Biology and Therapeutics, Yale University School of Medicine, Yale University, New Haven, CT, USA
| | - Yiren Liu
- Department of Vascular Surgery, Institute of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhu Tong
- Department of Vascular Surgery, Institute of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Institute of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Angle JF, Gasparetto A, Yokoi H, Jaff MR, Popma JJ, Piegari GN, Iyengar SS, Ohki T. Three-Year Efficacy and Safety of the Misago Peripheral Stent for Superficial Femoral Artery Disease: Final Results from the OSPREY Trial. J Vasc Interv Radiol 2020; 31:978-985. [PMID: 32414572 DOI: 10.1016/j.jvir.2020.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 01/05/2020] [Accepted: 01/05/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE This study evaluated the long-term outcomes of the Misago peripheral stent trial (Terumo) for atherosclerotic lesions in the superficial femoral artery (SFA) in patients with claudication. MATERIALS AND METHODS This was a prospective multicenter, single-arm, clinical trial of primary stent placement for de novo cases of SFA disease conducted in the United States and Asia. The primary endpoint was freedom from clinically driven target lesion revascularization (CD-TLR) at 36 months. Secondary outcomes were ankle-brachial index (ABI), Rutherford score, Walking Impairment Questionnaire (WIQ), a quality of life survey, and rate of device fracture. RESULTS A total of 276 patients (64.4% male; mean age, 69.3 ± 10.1 years) were enrolled. Freedom from CD-TLR was 78.5% (95% confidence interval [CI], 73.0%-83.0%) at 24 months and 75.4% (95% CI, 69.6%-80.2%) at 36 months. Baseline ABI was 0.7 ± 0.1 and 0.98 ± 0.20 (P < .001) at 30 days after the procedure. Baseline Rutherford score was 3.6 ± 0.6 and 1.6 ± 1.0 30 at 30 days after the procedure (P < .001). Mean (and changed) ABI and Rutherford score at 36 months compared to day 30 after the procedure were, respectively, 0.91 (-0.1 ± 0.2) and 1.5 (-0.2 ± 1.1). WIQ score at baseline was 21.49 ± 26.30 and 50.51 ± 38.49 at 30 days after the procedure ( P < .001). The mean WIQ score at 2 years was 46.65 ± 37.31 (P = .12). Stent fracture rate at 36 months was 2.0% (4 of 202 patients). CONCLUSIONS OSPREY (Occlusive-Stenotic Peripheral Artery Revascularization Study) 36-month data demonstrated persistent freedom from CD-TLR and sustained improvement in ABI and Rutherford score with primary stent placement for SFA lesions.
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Affiliation(s)
- John F Angle
- Department of Radiology, Department of Radiology, Hospital Expansion, Room 4080, University of Virginia Hospital, University of Virginia Health System,1215 Lee St., Charlottesville, VA 22908-0170.
| | | | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | | | - Jeffrey J Popma
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | | | - Takao Ohki
- Department of Surgery, Jikei University, Tokyo, Japan
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Hendriks JM, Dubois M, Lauwers P, de Vleeschauwer P, Vanbetsbrugge M, Deleersnijder R, Wustenberghs K, Robijn J, Jacobs B, Willaert W, Vandekerkhof J, Keirse K, Gabriëls K, Hoppenbrouwers M, Haesen D. Endovascular treatment of atherosclerotic lesions in the superficial femoral artery and proximal popliteal artery using the sinus-SuperFlex-635 stent: twelve-month results from the HERO Registry. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:84-92. [PMID: 32079379 DOI: 10.23736/s0021-9509.19.11028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the safety and performance of the sinus-SuperFlex-635 self-expandable nitinol stent (Optimed GmbH) for the treatment of steno-occlusive lesions in the superficial femoral artery (SFA) and proximal popliteal artery (PPA). METHODS The prospective, multicenter, observational HERO study recruited 117 eligible patients (83 men; mean age 69.4±9.7y) from 7 centers in Belgium. RESULTS A total of 129 stents were successfully deployed in 121 lesions in 117 patients (100%). The patients presented with symptomatic ≥50% stenosis or chronic total occlusion (CTO) (30.6%). Mean lesion length was 71.4±56.3 mm. Moderate to severe calcification was present in 82.6% of the lesions. Acute lesion success (<30% residual stenosis) was achieved in 96.0%. There were no in-hospital serious adverse events. Duplex ultrasound-driven primary patency at 12 months was recorded in 84 of 107 (78.5%) lesions. The overall target lesion revascularization (TLR) rate was 8.4% at 12 months; the target extremity revascularization (TER) rate was 4.7%. Clinical assessment at 12 months demonstrated improvement by at least 1 Rutherford class, without the need for TLR (i.e. primary sustained clinical improvement) in 83.9% of patients and with the need for TLR in 90.6% of patients (i.e. secondary sustained clinical improvement). CONCLUSIONS Based on the high primary patency, low stent fracture rate and significant clinical improvement, combined with refined stent design and long stent availability, the sinus-SuperFlex-635 self-expandable nitinol stent proves its value in the treatment of complex femoropopliteal lesions.
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Affiliation(s)
- Jeroen M Hendriks
- Department of Thorax and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium -
| | - Marc Dubois
- Department of Thorax and Vascular Surgery, Heilig-Hartziekenhuis Lier, Antwerp, Belgium
| | - Patrick Lauwers
- Department of Thorax and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | | | - Michiel Vanbetsbrugge
- Department of Thorax and Vascular Surgery, GZA Sint-Augustinus Wilrijk, Antwerp, Belgium
| | - Roderik Deleersnijder
- Department of Thorax and Vascular Surgery, GZA Sint-Augustinus Wilrijk, Antwerp, Belgium
| | - Karen Wustenberghs
- Department of Thorax and Vascular Surgery, GZA Sint-Augustinus Wilrijk, Antwerp, Belgium
| | - Jorn Robijn
- Department of Vascular and Thorax Surgery, General Hospital Jan Portaels Vilvoorde, Flemish Brabant, Belgium
| | - Bart Jacobs
- Department of Vascular Surgery, General Hospital Maria Middelares Gent, East Flanders, Belgium
| | - Willem Willaert
- Department of Vascular Surgery, General Hospital Maria Middelares Gent, East Flanders, Belgium
| | - Jos Vandekerkhof
- Department of Vascular Surgery, Jessa Hospital Hasselt, Limburg, Belgium
| | - Koen Keirse
- Department of Vascular Surgery, Regional Hospital Tienen, Flemish Brabant, Belgium
| | | | - Mieke Hoppenbrouwers
- Department of Thorax and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
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Gouëffic Y, Sauguet A, Desgranges P, Feugier P, Rosset E, Ducasse E, Kaladji A, Salomon du Mont L, Pernès JM, Commeau P, Lermusiaux P, Leclere B, Guyomarc’h B, Hoffmann CT, Maurel B. A Polymer-Free Paclitaxel-Eluting Stent Versus a Bare-Metal Stent for De Novo Femoropopliteal Lesions. JACC Cardiovasc Interv 2020; 13:447-457. [DOI: 10.1016/j.jcin.2019.12.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/25/2019] [Accepted: 12/03/2019] [Indexed: 11/26/2022]
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Frank U, Nikol S, Belch J, Boc V, Brodmann M, Carpentier PH, Chraim A, Canning C, Dimakakos E, Gottsäter A, Heiss C, Mazzolai L, Madaric J, Olinic DM, Pécsvárady Z, Poredoš P, Quéré I, Roztocil K, Stanek A, Vasic D, Visonà A, Wautrecht JC, Bulvas M, Colgan MP, Dorigo W, Houston G, Kahan T, Lawall H, Lindstedt I, Mahe G, Martini R, Pernod G, Przywara S, Righini M, Schlager O, Terlecki P. ESVM Guideline on peripheral arterial disease. VASA 2019; 48:1-79. [DOI: 10.1024/0301-1526/a000834] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Sato K, Emura S, Tomiyoshi H, Morita S. Morphologic Changes of the Femoropopliteal Arterial Segment with Knee Flexion after Endovascular Therapy. Ann Vasc Dis 2019; 12:210-215. [PMID: 31275476 PMCID: PMC6600111 DOI: 10.3400/avd.oa.18-00162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: The purpose of this study is to investigate morphologic changes of the femoropopliteal arterial segment (FPAS) with knee flexion after endovascular therapy (EVT). Methods: From July 2012 to January 2015, EVT was performed on 12 limbs in 12 consecutive patients who had obliterative lesions in the FPAS. After the implantation of nitinol stents, angiography was performed with the knee in both extension and flexion to investigate morphologic changes of the FPAS. Results: On angiography, the distal end of the implanted stent was placed at various distances (5–10 cm in two cases, 10–15 cm in nine cases, and 15–20 cm in one case) above the knee joint line with the knee in extension. In all cases, although the popliteal artery was highly bent with the knee in flexion, the FPAS morphology was highly variable. However, the most proximal bending point of the FPAS was about 10 cm above the knee joint line. In one case, the artery was occluded at the distal part of the stent 16 months later, probably due to EVT. Conclusion: In EVT of the FPAS, it is important to consider the characteristics and position of the stent to prevent complications.
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Affiliation(s)
- Katsutoshi Sato
- Department of Cardiovascular Surgery, National Hospital Organization, Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
| | - Shogo Emura
- Department of Cardiovascular Surgery, National Hospital Organization, Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
| | - Hideki Tomiyoshi
- Department of Radiology, National Hospital Organization, Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
| | - Satoru Morita
- Department of Cardiovascular Surgery, National Hospital Organization, Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
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Shinozaki N, Ikari Y. Superficial femoral artery stenting via radial access using R2P® Misago® stents: First-in-human report of the new R2P® system. SAGE Open Med Case Rep 2019; 7:2050313X19847348. [PMID: 31105950 PMCID: PMC6503586 DOI: 10.1177/2050313x19847348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 04/09/2019] [Indexed: 11/16/2022] Open
Abstract
A 73-year-old male with left critical limb ischemia was scheduled to undergo
below-the-knee amputation. Prior to the amputation, he was referred to our
institute for endovascular treatment. We inserted the new 7-Fr 150-cm-long
guiding catheter, SlenGuide®, into the external iliac artery from the
right radial artery with the 7-Fr Glidesheath Slender®. We implanted
two R2P® Misago® stents with rapid-exchange, 200-cm-long
shaft system in the stenosis of the left superficial femoral artery. This new
stent system involves rapid-exchange and a long shaft system; furthermore, it is
useful in transradial stenting in the superficial femoral artery.
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Affiliation(s)
- Norihiko Shinozaki
- Department of Cardiology, School of Medicine, Tokai University, Isehara, Japan
| | - Yuji Ikari
- Department of Cardiology, School of Medicine, Tokai University, Isehara, Japan
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Kawarada O, Nakai M, Nishimura K, Miwa H, Iwasaki Y, Kanno D, Nakama T, Yamamoto Y, Ogata N, Nakamura M, Yasuda S. Antithrombotic therapy after femoropopliteal artery stenting: 12-month results from Japan Postmarketing Surveillance. HEART ASIA 2019; 11:e011114. [PMID: 31031828 PMCID: PMC6454330 DOI: 10.1136/heartasia-2018-011114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/27/2018] [Accepted: 11/11/2018] [Indexed: 01/22/2023]
Abstract
Objective To investigate the effects of antithrombotic therapy on target lesion revascularisation (TLR) and major adverse cardiovascular and cerebrovascular events (MACCEs) at 12 months after femoropopliteal intervention with second-generation bare metal nitinol stents. Methods A total of 277 lesions in 258 limbs of 248 patients with de novo atherosclerosis in the above-the-knee femoropopliteal segment were analysed from the Japan multicentre postmarketing surveillance. Results At discharge, dual antiplatelet therapy (DAPT) was prescribed in 68.5% and cilostazol in 30.2% of patients. At 12 months of follow-up, prescriptions of DAPT significantly (p=0.0001) decreased to 51.2% and prescription of cilostazol remained unchanged (p=0.592) at 28.0%. Prescription of warfarin also remained unchanged (14.5% at discharge, 13.3% at 12 months, p=0.70). At 12 months, freedoms from TLR and MACCE were 89.4% and 89.7%, respectively. In a multivariate Cox proportional hazards model, neither DAPT nor cilostazol at discharge was associated with both TLR and MACCE at 12 months. However, warfarin at discharge was only independently associated with TLR at 12 months. Kaplan-Meier estimates demonstrated that warfarin at discharge yielded a significantly (p=0.013) lower freedom from TLR at 12 months than no warfarin at discharge. Freedom from TLR at 12 months by the Kaplan-Meier estimates was 77.8% (95% CI 59.0% to 88.8%) in patients with warfarin at discharge and 91.2% (95% CI 86.3% to 94.3%) in those without warfarin at discharge. Conclusions Clinical benefits of DAPT or cilostazol might be small in terms of TLR and MACCE at 12 months. Anticoagulation with warfarin at discharge might increase TLR at 12 months.
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Affiliation(s)
- Osami Kawarada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Michikazu Nakai
- Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hideki Miwa
- Clinical Development Department, Terumo Corporation, Tokyo, Japan
| | - Yusuke Iwasaki
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Daitaro Kanno
- Cardiovascular Medicine, Sapporo Cardiovascular Clinic, Hokkaido, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Yoshito Yamamoto
- Department of Cardiology, Iwaki Kyoritsu General Hospital, Fukushima, Japan
| | - Nobuhiko Ogata
- Department of Cardiology, Ageo Central General Hospital, Saitama, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
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Tsujimura T, Takahara M, Iida O, Hiramori S, Hayakawa N, Karashima E, Miura T, Teramura M, Ichihashi K, Kojima T, Aihara H, Yamaoka T, Fujihara M, Tosaka A, Doijiri T, Mano T, Soga Y. One-Year Clinical Outcomes following Implantation of Innova TM Self-Expanding Nitinol Stents in Patients with Peripheral Artery Diseases Presenting Femoropopliteal Artery Lesions. J Atheroscler Thromb 2019; 26:847-855. [PMID: 30842350 PMCID: PMC6800395 DOI: 10.5551/jat.47399] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: Although the Innova™ self-expanding nitinol stent (Boston Scientific, Marlborough, MA) exhibits acceptable performance in long-term safety and efficacy when used for the treatment of femoropopliteal (FP) lesions, clinical outcomes following its implantation have not been systematically studied in real-world settings. We investigated the one-year clinical outcomes after implantation of Innova™ self-expanding nitinol stents for the treatment of FP lesions in real-world settings. Methods: In this multicenter study, 481 lesions in 453 consecutive patients with peripheral artery disease (PAD) (74 ± 9 years; male, 70%; diabetes mellitus, 61%; dialysis, 27%; critical limb ischemia, 37%) who underwent endovascular therapy with the implantation of Innova™ self-expanding nitinol stents for FP lesions were analyzed from February 2016 to April 2017. The primary endpoint was one-year restenosis, whereas the secondary endpoints included one-year major adverse limb events and predictors for one-year restenosis. Results: The mean lesion length was 18 ± 10 cm. One-year restenosis and major adverse limb event rates were 36% and 18%, respectively. Multivariate analysis revealed that the presence of diabetes mellitus (odds ratio [OR]: 1.83; 95% confidence interval [CI]: 1.07–3.13), distal reference vessel diameter (OR: 1.86; 95% CI: 1.09–3.16), spot stenting (OR: 2.27; 95% CI: 1.27–4.06), and lack of one-year cilostazol treatment (OR: 0.58; 95% CI: 0.33–1.00) were independent risk factors for one-year restenosis. Conclusion: The current study demonstrated one-year clinical outcomes after Innova™ self-expanding nitinol stent placement for the treatment of FP lesions, including challenging cases in real-world settings.
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Affiliation(s)
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | | | | | | | - Takashi Miura
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | | | - Kei Ichihashi
- Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital
| | - Tai Kojima
- Department of Cardiology, Gifu Prefectural General Medical Center
| | - Hideaki Aihara
- Department of Cardiology, Tsukuba Medical Center Hospital
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Iida O, Soga Y, Urasawa K, Saito S, Jaff MR, Wang H, Ookubo H, Yokoi H. Drug-coated balloon versus uncoated percutaneous transluminal angioplasty for the treatment of atherosclerotic lesions in the superficial femoral and proximal popliteal artery: 2-year results of the MDT-2113 SFA Japan randomized trial. Catheter Cardiovasc Interv 2019; 93:664-672. [PMID: 30747489 PMCID: PMC6594002 DOI: 10.1002/ccd.28048] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 10/29/2018] [Accepted: 12/01/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To assess the longer-term safety and efficacy of the IN.PACT Admiral (MDT-2113) drug-coated balloon (DCB) for the treatment of de novo and non-stented restenotic lesions in the superficial femoral and/or proximal popliteal arteries versus uncoated percutaneous transluminal angioplasty (PTA) in a Japanese cohort. BACKGROUND Although DCBs are the newest endovascular strategy for patients with peripheral artery disease presenting with femoropopliteal lesions, there remains a paucity of results in non-Caucasian populations. METHODS IN.PACT SFA Japan is an independently-adjudicated, prospective, multicenter, randomized, single-blinded trial. Endpoints through 2 years included primary patency and a composite safety endpoint of freedom from device- and procedure-related death through 30 days, freedom from target limb major amputation and freedom from clinically-driven target vessel revascularization at 24 months. RESULTS One hundred patients were assigned by 2:1 randomization to treatment with the IN.PACT Admiral DCB (n = 68) or PTA (n = 32). The groups were well-matched at baseline. Mean lesion length for the DCB and PTA groups were 9.15 ± 5.85 and 8.89 ± 6.01 cm (P = 0.838), respectively. Patients treated with DCB exhibited superior 24-month primary patency compared to PTA (79.8% vs. 46.9%; log rank P < 0.001). The 24-month clinically driven target lesion revascularization rate was 9.1% for DCB versus 20.7% for PTA (P = 0.177). There were no device- or procedure-related deaths, major amputations, or thromboses in either group. CONCLUSIONS Two-year results from IN.PACT SFA Japan demonstrated persistently superior patency and low CD-TLR rates through 2 years when compared to uncoated PTA in Japanese patients. These data are consistent with other IN.PACT DCB trials.
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Nakamura M, Jaff MR, Settlage RA, Kichikawa K. Nitinol Self-Expanding Stents for the Treatment of Obstructive Superficial Femoral Artery Disease: Three-Year Results of the RELIABLE Japanese Multicenter Study. Ann Vasc Dis 2018; 11:324-334. [PMID: 30402183 PMCID: PMC6200612 DOI: 10.3400/avd.oa.18-00067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective: To assess the use of a nitinol stent to treat symptomatic stenoses or occlusions of the native superficial femoral artery (SFA). Materials and Methods: Seventy-four patients were treated at 12 Japanese sites. The primary endpoint, freedom from target-limb failure (TLF), was a composite of device- or procedure-related death, target-limb amputation, target-vessel revascularization (TVR), or restenosis compared to an objective performance goal (OPG) at 12 months. Secondary endpoints, including primary patency, freedom from TVR/target-lesion revascularization (TLR), improvements in clinical parameters, and major adverse events (MAEs) were evaluated through 36 months. Results: The mean overall lesion length was 80.7±38.9 mm (mean stented length: 98.8±46.1 mm). Freedom from TLF was 81.2% (p<0.001 compared to OPG) with a Kaplan–Meier estimate of 84.2% [95% confidence interval (95%CI) 73.3%, 90.9%] at 12 months. Primary patency was 71.0% at 12 months and 67.8% at 36 months. A total of 94.7% of patients improved by at least one Rutherford category and 70.2% of patients improved ankle–brachial indices ≧0.10 from baseline to 36 months. Freedom from TVR/TLR (Kaplan–Meier) was 90% at 12 months and 79.5% at 36 months. Four MAEs were reported; none were found to be device or procedure related. Conclusion: A self-expanding stent was used safely to treat stenotic and occlusive lesions of the SFA in a Japanese patient population. The composite endpoint, freedom from TLF, was superior to an historical control at one year, with low rates of revascularization and good functional and clinical outcomes through three years.
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Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Michael R Jaff
- Vascular Core Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Kimihiko Kichikawa
- Department of Radiology, Nara Medical University Hospital, Kashihara, Nara, Japan
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Jaff MR, Nelson T, Ferko N, Martinson M, Anderson LH, Hollmann S. Endovascular Interventions for Femoropopliteal Peripheral Artery Disease: A Network Meta-Analysis of Current Technologies. J Vasc Interv Radiol 2017; 28:1617-1627.e1. [PMID: 29031986 DOI: 10.1016/j.jvir.2017.08.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/04/2017] [Accepted: 08/04/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To use network meta-analysis (NMA) to determine the optimal endovascular strategy for management of femoropopliteal peripheral artery disease (PAD) given the lack of multiple prospective randomized trials to guide treatment decisions. MATERIALS AND METHODS NMA is a new meta-analytic method that permits comparisons among any 2 therapies by combining results of a collection of clinical trials conducted in the same or similar patient population. NMA was used to analyze data from 15 randomized controlled trials (RCTs) and 10 prospective, multicenter, single-arm trials (combined evidence [CE] NMA) that evaluated target lesion revascularization (TLR) for 5 endovascular strategies: bare metal stent (BMS), polymer-covered metal stent (CMS), drug-eluting stent (DES), drug-coated balloon (DCB) and percutaneous transluminal angioplasty (PTA). RESULTS The RCT and CE NMAs included 2,912 (6,091) patients with 3,151 (6,786) person-years of follow-up. In the CE NMA, DCB provided a statistically significant 68% reduction in TLR compared with PTA and a statistically significant 53% reduction in TLR compared with BMS. BMS, CMS, and DES provided reductions in TLR of 33%, 48%, and 58% compared with PTA, with statistical significance achieved for CMS and DES. The significant reductions in TLR for DCB compared with PTA and BMS were replicated in the RCT NMA. CONCLUSIONS This NMA demonstrated that DCB provided better reduction in TLR rates compared with PTA and BMS.
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Affiliation(s)
- Michael R Jaff
- Department of Medicine, Newton-Wellesley Hospital, 2014 Washington Street, Newton, MA 02462.
| | | | - Nicole Ferko
- Cornerstone Research Group, Burlington, Ontario, Canada
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Retrospective Multicenter Comparison of S.M.A.R.T. CONTROL and MISAGO Stents in Treatment of Femoropopliteal Lesions. J Vasc Interv Radiol 2016; 27:1642-1649. [PMID: 27567999 DOI: 10.1016/j.jvir.2016.05.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 05/29/2016] [Accepted: 05/29/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare primary patency between MISAGO (Terumo Corporation, Tokyo, Japan) and S.M.A.R.T. CONTROL (Cordis Corporation, Miami Lakes, Florida), second-generation and first-generation nitinol stents, in femoropopliteal lesions. MATERIALS AND METHODS This multicenter, retrospective study included 240 cases with MISAGO stent implantation and 1,265 cases with S.M.A.R.T. stent implantation. The S.M.A.R.T. group had more Trans-Atlantic Inter-Society of Consensus (TASC) II class C/D lesions (53% vs 41%, P = .001) and smaller reference vessel diameter (RVD) (5.3 mm ± 0.9 vs 5.5 mm ± 0.9, P < .001). RESULTS Kaplan-Meier estimates of 2-year primary patency after S.M.A.R.T. and MISAGO stent implantation were 67% and 55% (P = .007). Interaction analysis revealed that TASC II classification and RVD had a significant influence on the association of MISAGO versus S.M.A.R.T. stents with the outcome. The study population was stratified according to TASC II classification and RVD, and MISAGO and S.M.A.R.T. stents were compared after propensity score matching. There was no significant difference in 2-year patency between the 2 stents in the subgroup with TASC II class A/B and RVD ≥ 5 mm (S.M.A.R.T. 82% ± 4 vs MISAGO 74% ± 5, P = .480). MISAGO stents had lower primary patency than S.M.A.R.T. stents in cases with TASC II class C/D or RVD < 5 mm (S.M.A.R.T. 62% ± 6 vs MISAGO 25% ± 6, P = .015). CONCLUSIONS S.M.A.R.T. and MISAGO stents had similar patency in simple lesions, but MISAGO stents had lower patency than S.M.A.R.T. stents in more complex lesions.
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Treitl M, Reiser MF, Treitl KM. [Stent-assisted recanalization of femoropopliteal arterial occlusive disease. Influence of stent design on patency rates]. Radiologe 2016; 56:233-9. [PMID: 26842999 DOI: 10.1007/s00117-016-0077-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite enormous technical progress the results of endovascular treatment of the femoropopliteal vasculature are unsatisfactory and its role is still controversially discussed. In the past decade numerous new stent designs have come onto the market but it is unclear whether they have benefits with respect to patency rates. OBJECTIVES Comparison of published data on patency rates and target lesion revascularization rates after use of different stent designs in the femoropopliteal vasculature. MATERIAL AND METHODS Analysis of 25 published studies and registries from 2006 to 2015 for classical open-cell stents, interwoven stents and partially or fully covered stents. RESULTS AND CONCLUSION The published data are heterogeneous and comparative studies for different stent designs are completely missing. Over the past decade the patency rates after femoropopliteal stenting could be improved. According to available data stenting of short lesions < 5 cm does not show any benefit compared to isolated balloon angioplasty. Primary stenting is now recommended for intermediate and longer lesions > 6.4 cm. Due to the heterogeneity of published data a clear benefit for a specific stent design is not obvious; however, data for interwoven stents are promising and show a tendency towards improved patency, at least for certain lesions. Randomized controlled comparative trials are needed to confirm this result.
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Affiliation(s)
- M Treitl
- Institut für Klinische Radiologie, Ludwig-Maximilians-Universität München, Nussbaumstr. 20, 80336, München, Deutschland.
| | - M F Reiser
- Institut für Klinische Radiologie, Ludwig-Maximilians-Universität München, Nussbaumstr. 20, 80336, München, Deutschland
| | - K M Treitl
- Institut für Klinische Radiologie, Ludwig-Maximilians-Universität München, Nussbaumstr. 20, 80336, München, Deutschland
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One-year outcomes of the U.S. and Japanese regulatory trial of the Misago stent for treatment of superficial femoral artery disease (OSPREY study). J Vasc Surg 2016; 63:370-6.e1. [DOI: 10.1016/j.jvs.2015.08.093] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 08/18/2015] [Indexed: 11/23/2022]
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Iida O, Takahara M, Soga Y, Suzuki K, Hirano K, Kawasaki D, Shintani Y, Suematsu N, Yamaoka T, Nanto S, Uematsu M. Efficacy of intravascular ultrasound in femoropopliteal stenting for peripheral artery disease with TASC II class A to C lesions. J Endovasc Ther 2015; 21:485-92. [PMID: 25101575 DOI: 10.1583/14-4721r.1] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate whether use of intravascular ultrasound (IVUS) improves primary patency following nitinol stenting for TASC II (TransAtlantic Inter-Society Consensus) A-C femoropopliteal lesions. METHODS Using a retrospective multicenter database of 1198 limbs from 965 patients (695 men; mean age 72±9 years) with TASC II A-C lesions (28% critical limb ischemia) treated by provisional stenting from April 2004 to December 2011, primary patency rate was compared between 234 propensity score-matched pairs with vs. without IVUS use. RESULTS IVUS was used in 22% (n=268) of the overall population. It was more likely to be used in cases with generally more complicated femoropopliteal lesions (e.g., more severe TASC II class, longer lesion length, and narrower reference diameter). Analysis of the 234 propensity score-matched pairs (mean follow-up 1.9±1.5 years; 142 events) revealed higher 5-year primary patency with than without IVUS use (65%±6% vs. 35%±6%, p<0.001). IVUS resulted in significantly better assisted primary patency (p<0.001), secondary patency (p=0.004), freedom from any reintervention (p<0.001), freedom from any adverse limb event (p<0.001), and event-free survival (p<0.001). CONCLUSION IVUS use in femoropopliteal stenting for TASC II A-C lesions appears to be associated with higher primary patency rate.
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Affiliation(s)
- Osamu Iida
- 1 Department of Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
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Gouëffic Y, Kaladji A. Commentary: the clinical relevance of superficial femoral artery stent fractures remains obscure. J Endovasc Ther 2015; 22:327-9. [PMID: 25904487 DOI: 10.1177/1526602815583662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yann Gouëffic
- CHU Nantes, l'institut du thorax, service de chirurgie vasculaire, Nantes, France Laboratoire de Physiopathologie de la Résorption osseuse, Inserm-UN UMR-957, Nantes, France
| | - Adrien Kaladji
- CHU Nantes, l'institut du thorax, service de chirurgie vasculaire, Nantes, France
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Mori S, Hirano K, Nakano M, Muramatsu T, Tsukahara R, Ito Y, Ishimori H. Intravascular Ultrasound Measurements After Drug-Eluting Stent Placement in Femoropopliteal Lesions. J Endovasc Ther 2015; 22:341-9. [DOI: 10.1177/1526602815580308] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To investigate the relationship between postprocedure intravascular ultrasound (IVUS) findings and restenosis after placement of drug-eluting stents (DES) for femoropopliteal lesions. Methods: Between July 2012 and May 2013, DES were placed in 64 patients with 88 de novo femoropopliteal lesions. In 40 patients (mean age 74.2±9.4 years; 27 men), DES were placed in 50 lesions under IVUS guidance, and restenosis was monitored for 1 year. All patients were symptomatic (Rutherford 2–6), and 17 patients (43%) suffered from critical limb ischemia. IVUS findings after stenting were compared for patients with vs without restenosis, which was defined as a peak systolic velocity ratio >2.4 on duplex ultrasonography or >50% diameter stenosis on angiography. Results: Ten patients (14 lesions) developed restenosis, while 30 patients (36 lesions) did not. There were no significant differences in the frequency of diabetes or dialysis between the 2 groups. Female patients were predominant in the restenosis group (p<0.003). There were no significant differences of the percentage of TransAtlantic Inter-Society Consensus C/D lesions or stent edge dissection. Multivariate analysis indicated that cilostazol use [odds ratio (OR) 0.13; p=0.046], distal lumen cross-sectional area (CSA) (OR 0.86; p=0.035), and axial symmetry index (OR 0.60; p=0.045) were independent predictors of restenosis. Using receiver operator characteristic analysis, the best cutoff values of the distal lumen CSA and axial symmetry index for predicting restenosis were 17.1 cm2 and 0.6, respectively. Conclusion: IVUS guidance of DES placement in femoropopliteal lesions can offer useful predictors of restenosis at 1 year. The utility of distal lumen CSA and the axial symmetry index in the prediction of restenosis after femoropopliteal DES placement should be confirmed in a larger cohort.
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Affiliation(s)
- Shinsuke Mori
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan
| | - Keisuke Hirano
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan
| | - Masatsugu Nakano
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan
| | - Toshiya Muramatsu
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan
| | - Reiko Tsukahara
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan
| | - Hiroshi Ishimori
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan
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Sarkadi H, Bérczi V, Kollár A, Kiss D, Jakabfi P, Végh E, Nemes B, Merkely B, Hüttl K, Dósa E. Safety, Clinical Outcome, and Fracture Rate of Femoropopliteal Stenting Using a 4F Compatible Delivery System. Eur J Vasc Endovasc Surg 2015; 49:199-204. [DOI: 10.1016/j.ejvs.2014.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
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Gouëffic Y, Kaladji A, Guyomarch B, Montagne C, Fairier D, Gestin S, Riche VP, Vent PA, Chaillou P, Costargent A, Patra P. Bare metal stent versus paclitaxel eluting stent for intermediate length femoropopliteal arterial lesions (BATTLE trial): study protocol for a randomized controlled trial. Trials 2014; 15:423. [PMID: 25359394 PMCID: PMC4226912 DOI: 10.1186/1745-6215-15-423] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 10/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, endovascular treatment is indicated to treat femoropopliteal lesions ≤15 cm. However, the Achilles' heel of femoropopliteal endovascular repair remains restenosis. Paclitaxel eluting stents have shown promising results to prevent restenosis in femoropopliteal lesions compared to percutaneous transluminal angioplasty. A recently released prospective registry using a newer generation of self-expandable nitinol stents (Misago®; Terumo Corp., Tokyo, Japan) supports primary bare metal stenting as a first-line treatment for femoropopliteal lesions. To date, no studies have been designed to compare bare metal stents to paclitaxel eluting stents for the treatment of femoropoliteal lesions. The BATTLE trial was designed to compare paclitaxel eluting stents (Zilver® PTX®) and a last generation bare self-expandable nitinol stents (Misago® RX, Terumo Corp., Tokyo, Japan) in the treatment of intermediate length femoropopliteal lesions (≤14 cm). METHODS/DESIGN A prospective, randomized (1:1), controlled, multicentric and international study has been designed. One hundred and eighty-six patients fulfilling the inclusion criteria will be randomized to one of the two assessments of endovascular repair to treat de novo femoropopliteal lesions ≤14 cm in symptomatic patients (Rutherford 2 to 5): bare stent group and paclitaxel eluting stent group. The primary endpoint is freedom from in-stent restenosis at 1 year defined by a peak systolic velocity index >2.4 (restenosis of >50%) at the target lesion and assessed by duplex scan. Our main objective is to demonstrate the clinical superiority of primary stenting using Zilver® PTX® stent system versus bare metal self-expandable stenting in the treatment of femoropopliteal lesions in patients with symptomatic peripheral arterial disease. DISCUSSION This is the first randomized and controlled study to compare the efficacy of bare metal stents and paclitaxel eluting stents for the treatment of femoropopliteal lesions. It may clarify the indication of stent choice for femoropopliteal lesions of intermediate length. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02004951. 3 December 2013.
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Affiliation(s)
- Yann Gouëffic
- />CHU Nantes, l’institut du thorax, service de chirurgie vasculaire, Nantes, F-44000 France
- />INSERM, U957, Nantes, F-44000 France
- />Université de Nantes, Nantes, F-44000 France
| | - Adrien Kaladji
- />CHU Nantes, l’institut du thorax, service de chirurgie vasculaire, Nantes, F-44000 France
| | - Béatrice Guyomarch
- />CHU Nantes, l’institut du thorax, centre d’investigation clinique, Nantes, F-44000 France
| | - Carine Montagne
- />CHU Nantes, l’institut du thorax, centre d’investigation clinique, Nantes, F-44000 France
| | - Damien Fairier
- />CHU Nantes, l’institut du thorax, centre d’investigation clinique, Nantes, F-44000 France
| | - Simon Gestin
- />CHU Brest, service de médecine interne 1 et de médecine vasculaire, Brest, F-29200 France
| | - Valéry-Pierre Riche
- />CHU Nantes, l’institut du thorax, centre d’investigation clinique, Nantes, F-44000 France
| | - Pierre Alexandre Vent
- />CHU Nantes, l’institut du thorax, service de chirurgie vasculaire, Nantes, F-44000 France
| | - Philippe Chaillou
- />CHU Nantes, l’institut du thorax, service de chirurgie vasculaire, Nantes, F-44000 France
| | - Alain Costargent
- />CHU Nantes, l’institut du thorax, service de chirurgie vasculaire, Nantes, F-44000 France
| | - Philippe Patra
- />CHU Nantes, l’institut du thorax, service de chirurgie vasculaire, Nantes, F-44000 France
- />Université de Nantes, Nantes, F-44000 France
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Bosiers M, Deloose K, Callaert J, Keirse K, Verbist J, Hendriks J, Lauwers P, D'Archambeau O, Scheinert D, Torsello G, Peeters P. 4-French-compatible endovascular material is safe and effective in the treatment of femoropopliteal occlusive disease: results of the 4-EVER trial. J Endovasc Ther 2014; 20:746-56. [PMID: 24325689 DOI: 10.1583/13-4437mr.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To report the 1-year results of a prospective multicenter trial to evaluate the safety and efficacy of treating symptomatic femoropopliteal occlusive disease using 4-F-compatible materials and no closure device. METHODS The non-randomized 4-EVER trial (4-F endovascular treatment approach to infrainguinal disease) was conducted at 5 European hospitals (ClinicalTrials.gov identifier NCT01413139). The protocol mandated the use of only 4-F sheaths, self-expanding nitinol stents (Astron Pulsar or Pulsar-18 stent), and balloons from a single manufacturer. Between June 2010 and June 2011, 120 symptomatic patients (82 men; mean age 71±9.7 years, range 47-90), primarily claudicants, treated for 120 femoropopliteal lesions (>90% TASC A/B) were enrolled. The mean lesion length was 71.0±45.9 mm. Follow-up evaluations were scheduled on day 1 and at 1, 6, 12, and 24 months. A duplex ultrasound was performed on all follow-up visits to determine vessel patency (primary outcome measure at 1 year), and biplanar radiography was performed at 12 and 24 months to assess stent fracture. RESULTS Stents were successfully implanted in all patients: an Astron Pulsar stent in 70 (58.3%) lesions and a Pulsar-18 stent in 46 (38.3%); 4 (3.3%) patients had both stents implanted for flow-limiting dissection after predilation. No closure devices were used; the mean manual compression time was 8.1 minutes (2-15). Four (3.3%) patients developed significant hematoma at the puncture site, but none required surgical repair. The overall 12-month primary patency rate was 81.4%: 85.2% for the Astron Pulsar and 73.4% for the Pulsar-18 (p=0.236). Freedom from target lesion revascularization at 12 months for the entire cohort was 89.3%. CONCLUSION Compared to published historical data for superficial femoral artery type A/B lesion stenting using 6-F devices, the 4-F devices applied in this trial showed similar patency at 12 months, fewer access site complications, and shorter manual compression times, supporting the supposition that 4-F endovascular treatment is safe and effective.
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Affiliation(s)
- Marc Bosiers
- 1 Department of Vascular Surgery, A.Z. Sint-Blasius, Dendermonde, Belgium
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Krankenberg H, Tübler T, Sixt S, Fischer M, Schmiedel R, Schulte KL, Balzer JO, Kieback A, Fiehn E, Wittenberg G, Ali T, Tiefenbacher C, Jahnke T, Steinkamp HJ, Wegscheider K, Treszl A, Ingwersen M, Zeller T. German Multicenter Real-World Registry of Stenting for Superficial Femoral Artery Disease: Clinical Results and Predictive Factors for Revascularization. J Endovasc Ther 2014; 21:463-71. [DOI: 10.1583/13-4625r.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lichtenberg M, Kolks O, Hailer B, Stahlhoff WF, Tiefenbacher C, Nolte-Ernsting C, Arjumand J, Wittenberg G. PEACE I All-Comers Registry: Patency Evaluation After Implantation of the 4-French Pulsar-18 Self-Expanding Nitinol Stent in Femoropopliteal Lesions. J Endovasc Ther 2014; 21:373-80. [DOI: 10.1583/13-4637r.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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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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Marmagkiolis K, Hakeem A, Choksi N, Al-Hawwas M, Edupuganti MMR, Leesar MA, Cilingiroglu M. 12-month primary patency rates of contemporary endovascular device therapy for femoro-popliteal occlusive disease in 6,024 patients: beyond balloon angioplasty. Catheter Cardiovasc Interv 2014; 84:555-64. [PMID: 24740749 DOI: 10.1002/ccd.25510] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 02/27/2014] [Accepted: 04/06/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Endovascular approach to superficial femoral artery (SFA) disease, the most common cause of symptomatic peripheral arterial disease, remains fraught with high failure rates. Newer devices including second-generation nitinol stents, drug-coated stents, drug-coated balloons, covered stents, cryo-therapy, LASER, and directional atherectomy have shown promising results. Clinical equipoise still persists regarding the optimal selection of devices, largely attributable to the different inclusion criteria, study population, length of lesions treated, definition of "patency" and "restenosis," and follow-up methods in the pivotal trials. METHODS A prospective protocol was developed. We performed a literature search using PubMed from January 2006 to November 2013. Published articles including endovascular interventions in SFA or popliteal arteries with reported 12-month "primary patency" or "binary restenosis" rates as endpoints were included. RESULTS We identified 6,024 patients in 61 trials reporting 12-month primary patency rates in patients with femoropoliteal disease. Primary patency rates were (weighted average) 77.2% for nitinol stents, 68.8% for covered stents, 84% for drug eluting stents, 78.2% for drug eluting/coated balloon, 60.7% for cryoballoon, 51.1% for LASER atherectomy, 63.5% for directional atherectomy and 70.2% with a combination of endovascular devices. CONCLUSION The most frequently used endovascular devices yielded various 12-month primary patency rates ranging from 51% to 85%. The increased variation in inclusion criteria, length, and complexity of lesions between studies does not allow direct comparison between them. Larger randomized trials in specific patient populations comparing those modalities is needed before we can make safe recommendation of the superiority of one device over the other.
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Palena LM, Manzi M. Direct stent puncture technique for intraluminal stent recanalization in the superficial femoral and popliteal arteries in-stent occlusion: outcomes from a prospective clinical analysis of diabetics with critical limb ischemia. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 14:203-6. [PMID: 23928313 DOI: 10.1016/j.carrev.2013.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/21/2013] [Accepted: 05/02/2013] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of "Direct Stent Puncture" technique for intraluminal stent recanalization in the femoro-popliteal segments. METHODS AND MATERIALS A cohort of diabetics who had symptomatic in-stent occlusion of the superficial femoral or popliteal arteries underwent endovascular recanalization. After antegrade failure, direct stent puncture technique was performed. The primary end-point was to efficacy assessment, intended as technical success and clinical improvement. The secondary end-point was safety assessment, intended as free of complication rate. RESULTS Fifty-four patients (37 men; 73.6±8.5 years) underwent direct stent puncture technique, after several unsuccessful antegrade attempts to cross the occluded stent. Technical success for intraluminal stent recanalization was achieved in 53/54 (98.2%) of cases and failed in 1/54 (1.8%). Clinical improvement was obtained in 51/54 (94.4%) of cases, with regression of the clinical symptoms and improvement of the TcPO2, from 3±18 mmHg to 43±11 mmHg after 15 days (p<0.001). Free of complications rate was 92.5%. In 2/54 (3.7%) of cases distal embolization occurred, in 1/54 (1.9%) case a sudden vessel thrombosis was diagnosed after 12 hours and in 1/54 (1.9%) case hematoma at the stent puncture site was observed. CONCLUSIONS Direct Stent Puncture technique is an efficacy and safety option for intraluminal stent recanalization in the femoro-popliteal segment in-stent occlusion.
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Affiliation(s)
- Luis Mariano Palena
- Foot & Ankle Clinic, Interventional Radiology Unit, Policlinico Abano Terme, Piazza C. Colombo 1, 35031-Abano Terme (PD), Italy.
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Armstrong EJ, Laird JR. Commentary: Treatment of Femoropopliteal In-Stent Restenosis for Patients With Diabetes: Do We Have an Answer to the DEBATE? J Endovasc Ther 2014; 21:9-11. [DOI: 10.1583/13-4420c.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lichtenberg M, Hailer B, Kaeunicke M, Stahlhoff WF, Boese D, Breuckmann F. Evaluation of the 4-French Pulsar-18 Self-expanding Nitinol Stent in Long Femoropopliteal Lesions. CLINICAL MEDICINE INSIGHTS: CARDIOLOGY 2014; 8:37-42. [PMID: 25922584 PMCID: PMC4395046 DOI: 10.4137/cmc.s15224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/12/2014] [Accepted: 10/21/2014] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To evaluate the patency and the freedom of target lesion revascularization of the 4-French Pulsar-18 self-expandable (SE) nitinol stent for the treatment of long femoropopliteal occlusive disease in a two-center, prospective, all-comers registry with a follow-up period of 12 months. METHODS This registry enrolled 36 patients with symptomatic femoropopliteal long lesions for recanalization and implantation of the 4-French Pulsar-18 SE nitinol stent. Routine follow-up examination including duplex ultrasound was performed after 6 and 12 months. Primary patency was defined as no binary restenosis on duplex ultrasound (Peak systolic velocitiy ration (PSVR) <2.5) and no target lesion revascularization was performed within 12 months’ follow-up. No drug-eluting devices were allowed in this registry. RESULTS Average lesion length of the femoropopliteal segment was 182.3 ± 51.8 mm. Mean stent implantation length was 181.5 ± 35.4 mm. Total occlusion was present in 46 of the 48 (95.8%) treated lesions. Involvement of popliteal segment I–III was present in 3 (6.3%) lesions. The primary patency after 6 and 12 months was 87.5% and 85.4%, respectively. The clinically driven overall freedom from target lesion revascularization (fTLR) was 89.6% after 6 months and 87.5% after 12 months. ABI, pain-free walking distance and Rutherford category, all improved significantly (P < 0.001) after 6 and 12 months. The primary patency rate in patients with diabetes (P = 0.18) and renal insufficiency (P = 0.3) was not significantly lower as compared to the overall primary patency. CONCLUSIONS In this two-center, all-comers registry, the use of the Pulsar-18 SE nitinol stent for endovascular intervention of femoropopliteal disease with a mean lesion length of 182.3 ± 51.8 mm showed promising primary patency and fTLR rates after 6 and 12 months. Diabetes and renal insufficiency had no negative impact on the patency rate.
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Affiliation(s)
| | - Birgit Hailer
- Katholisches Klinikum Essen, Cardiovascular Clinic, Essen, Germany
| | | | | | - Dirk Boese
- Klinikum Arnsberg, Vascular Centre, Arnsberg, Germany
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Werner M, Piorkowski M, Thieme M, Nanning T, Beschorner U, Rastan A, Zeller T, Scheinert D. SUMMIT registry: one-year outcomes after implantation of the EPIC self-expanding nitinol stent in the femoropopliteal segment. J Endovasc Ther 2013; 20:759-66. [PMID: 24325691 DOI: 10.1583/13-4430r.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of the EPIC self-expanding nitinol stent in patients with femoropopliteal occlusive disease. METHODS The prospective, multicenter, nonrandomized SUMMIT study (ClinicalTrials.gov identifier NCT01336101) enrolled 100 patients (76 men; mean age 67.6 years) with symptomatic de novo femoropopliteal disease undergoing angioplasty and subsequent implantation of EPIC stents from April 2011 to October 2011. The mean lesion length was 69.5±40.5 mm; 29 of the lesions were total occlusions. Clinical examination and duplex sonography were prospectively performed after 6 and 12 months. The primary endpoint was in-stent restenosis as assessed by duplex ultrasound (peak systolic velocity ratio ≥2.5). Further outcome measures were patency rates, improvement in the Rutherford category and ankle-brachial index (ABI), as well as stent integrity based on plain radiography. RESULTS A residual stenosis <30% was achieved in all procedures. The primary patency rates were 96.8% after 6 months and 85.1% at 1 year. The secondary patency rates were 97.9% and 91.2% at the same intervals. The 1-year binary >50% restenosis rate was 15.7%. Freedom from target lesion revascularization at 1 year was 92.3%. Between baseline and the 12-month follow-up, the mean ABI increased from 0.73 to 0.96, and the mean Rutherford category decreased from 2.9 to 1.0 (p<0.001 for both comparisons). Plain radiographs from 86 patients at the 12-month examination confirmed the absence of stent fractures. CONCLUSION The outcome of the SUMMIT registry demonstrates that the EPIC self-expanding nitinol vascular stent is a safe and effective device for treating peripheral artery disease in the femoropopliteal segment.
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Affiliation(s)
- Martin Werner
- 1 Center for Vascular Medicine, Park Hospital Leipzig, Germany
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Armstrong EJ. Commentary: nitinol stents for femoropopliteal disease: what is the view from the SUMMIT? J Endovasc Ther 2013; 20:767-9. [PMID: 24325692 DOI: 10.1583/13-4430c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ehrin J Armstrong
- Division of Cardiology, University of Colorado, VA Eastern Colorado Healthcare System, Denver, Colorado, USA
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Rastan A, Krankenberg H, Baumgartner I, Blessing E, Müller-Hülsbeck S, Pilger E, Scheinert D, Lammer J, Gißler M, Noory E, Neumann FJ, Zeller T. Stent Placement Versus Balloon Angioplasty for the Treatment of Obstructive Lesions of the Popliteal Artery. Circulation 2013; 127:2535-41. [DOI: 10.1161/circulationaha.113.001849] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background—
Stenting has been shown to improve patency after femoral artery revascularization compared with balloon angioplasty. Limited data are available evaluating endovascular treatment for obstructive lesions of the popliteal artery.
Methods and Results—
This prospective, randomized, multicenter trial compared primary nitinol stent placement to percutaneous transluminal balloon angioplasty in patients with peripheral artery disease Rutherford-Becker class 2 to 5 who had a de novo lesion in the popliteal artery. The primary study end point was 1-year primary patency, defined as freedom from target-lesion restenosis (luminal narrowing of ≥50%) as detected by duplex ultrasound. Secondary end points included target-lesion revascularization rate and changes in Rutherford-Becker class. Provisional stent placement was considered target-lesion revascularization and loss of primary patency. Two hundred forty-six patients were included in this trial. The mean target-lesion length was 42.3 mm. One hundred ninety-seven patients were available for the1-year follow-up. The 1-year primary patency rate was significantly higher in the group with primary nitinol stent placement (67.4%) than in the percutaneous transluminal balloon angioplasty group (44.9%,
P
=0.002). Target-lesion revascularization rates were 14.7% and 44.1%, respectively (
P
=0.0001); however, when provisional nitinol stent placement was not considered target-lesion revascularization and loss in patency, no significant differences prevailed between the study groups (67.4% versus 65.7%,
P
=0.92 for primary patency). Approximately 73% of patients in the percutaneous transluminal balloon angioplasty group and 77% in the nitinol stent group showed an improvement of ≥1 Rutherford-Becker class (
P
=0.31).
Conclusions—
Primary nitinol stent placement for obstructive lesions of the popliteal artery achieves superior acute technical success and higher 1-year primary patency only if provisional stenting is considered target-lesion revascularization. Provisional stenting as part of a percutaneous transluminal balloon angioplasty strategy has equivalent 1-year patency and should be preferred over primary stenting.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00712309.
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Affiliation(s)
- Aljoscha Rastan
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Hans Krankenberg
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Iris Baumgartner
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Erwin Blessing
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Stefan Müller-Hülsbeck
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Ernst Pilger
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Dierk Scheinert
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Johannes Lammer
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Martin Gißler
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Elias Noory
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Franz-Josef Neumann
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
| | - Thomas Zeller
- From Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (A.R., E.N., F.-J.N., T.Z.); Universitäres Herz-und Gefäßzentrum Hamburg, Germany (H.K.); Klinik und Poliklinik für Angiologie, Departement Herz und Gefässe, Universität Bern, Bern, Switzerland (I.B.); Uniklinikum Heidelberg, Medizinische Klinik, Innere Medizin III, Heidelberg, Germany (E.B.); Ev.-Luth. Diakonissenkrankenhaus, Abteilung Radiologie, Flensburg, Germany (S.M.-H.)
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Stenting in lower limb arteries is reliable. Br J Hosp Med (Lond) 2013. [DOI: 10.12968/hmed.2013.74.1.8a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Armstrong EJ, Laird JR. Commentary: The MISAGO registry: a rapid-exchange superficial femoral artery stent for a rapidly expanding field. J Endovasc Ther 2012; 19:785-7. [PMID: 23210877 DOI: 10.1583/jevt-12-3861c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ehrin J Armstrong
- Division of Cardiovascular Medicine and Vascular Center, University of California, Davis Medical Center, Sacramento, California, USA
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