Skip to main content
Erschienen in: European Radiology 4/2009

01.04.2009 | Vascular-Interventional

The evaluation of primary stenting of sirolimus-eluting versus bare-metal stents in the treatment of atherosclerotic lesions of crural arteries

verfasst von: Aleksander Falkowski, Wojciech Poncyljusz, Grażyna Wilk, Małgorzata Szczerbo-Trojanowska

Erschienen in: European Radiology | Ausgabe 4/2009

Einloggen, um Zugang zu erhalten

Abstract

A comparison was made of sirolimus–eluting stents and bare stents as an effective means of treatment of stenosis in crural arteries. Patients were randomly divided into two groups: (1) patients treated with sirolimus-eluting stents and (2) patients treated with bare stents. Each group consisted of 25 patients, and every patient had one stent implanted. All patients showed symptoms of ischemia of the peripheral arteries, classified according to the Rutherford scale into categories 3, 4, and 5. All patients were examined 24 h before and 24 h and 6 months after the intervention. The results were analyzed according to clinical, hemodynamic, and angiographic criteria. Technically, the procedure was successful in 100% of cases, and both groups presented an equal improvement in clinical and hemodynamic parameters. The follow-up angiographic examination demonstrated a significantly lower rate of restenosis among the sirolimus-eluting stent group (4, 16%) versus the bare stent group (19, 76%) (p < 0.001), with lower target lesion revascularization in 3 (12%) versus 14 (56%) (p < 0.05), respectively. Quantitative angiography demonstrated that all variables used to assess restenosis were superior for sirolimus-eluting stents 6 months after intervention: late lumen loss 0.46 ± 0.72 versus 1.70 ± 0.94 (p < 0.001) and minimal lumen diameter 2.25 ± 0.82 versus 0.99 ± 1.08 (p < 0.001). Results of this study reveal that the use of sirolimus-eluting stents decreases the risk of restenosis in comparison to standard stents.
Literatur
1.
Zurück zum Zitat ICAI Study Group (1996) A prospective epidemiological survey of the natural history of chronic critical leg ischemia. Eur J Vasc Endovasc Surg 11:112–120CrossRef ICAI Study Group (1996) A prospective epidemiological survey of the natural history of chronic critical leg ischemia. Eur J Vasc Endovasc Surg 11:112–120CrossRef
2.
Zurück zum Zitat Schillinger M, Exner M, Mlekusch W, Haumer M, Rumpold H, Ahmadi R et al (2003) Endovascular revascularization below the knee: 6-month results and predictive value of C-reactive protein level. Radiology 227:419–425PubMedCrossRef Schillinger M, Exner M, Mlekusch W, Haumer M, Rumpold H, Ahmadi R et al (2003) Endovascular revascularization below the knee: 6-month results and predictive value of C-reactive protein level. Radiology 227:419–425PubMedCrossRef
3.
Zurück zum Zitat Balmer H, Mahler F, Do DD, Triller J, Baumgartner I (2002) Balloon angioplasty in chronic critical limb ischemia: factors affecting clinical and angiographic outcome. J Endovasc Ther 9:403–410PubMedCrossRef Balmer H, Mahler F, Do DD, Triller J, Baumgartner I (2002) Balloon angioplasty in chronic critical limb ischemia: factors affecting clinical and angiographic outcome. J Endovasc Ther 9:403–410PubMedCrossRef
4.
Zurück zum Zitat Holm J, Arfvidsson B, Jivegard L, Lundgren F, Lundholm K, Scherstén T et al (1991) Chronic lower limb ischaemia. A prospective randomised controlled study comparing the 1-year results of vascular surgery and percutaneous transluminal angioplasty (PTA). Eur J Vasc Surg 5:517–522PubMedCrossRef Holm J, Arfvidsson B, Jivegard L, Lundgren F, Lundholm K, Scherstén T et al (1991) Chronic lower limb ischaemia. A prospective randomised controlled study comparing the 1-year results of vascular surgery and percutaneous transluminal angioplasty (PTA). Eur J Vasc Surg 5:517–522PubMedCrossRef
5.
Zurück zum Zitat Nasr MK, McCarthy RJ, Hardman J, Chalmers A, Horrocks M (2002) The increasing role of percutaneous transluminal angioplasty in the primary management of critical limb ischaemia. Eur J Vasc Endovasc Surg 23:398–403PubMedCrossRef Nasr MK, McCarthy RJ, Hardman J, Chalmers A, Horrocks M (2002) The increasing role of percutaneous transluminal angioplasty in the primary management of critical limb ischaemia. Eur J Vasc Endovasc Surg 23:398–403PubMedCrossRef
6.
Zurück zum Zitat Ingle H, Nasim A, Bolia A, Fishwick G, Naylor R, Bell PR (2002) Subintimal angioplasty of isolated infragenicular vessels in lower limb ischemia:long-term results. J Endovasc Ther 9:411–416PubMedCrossRef Ingle H, Nasim A, Bolia A, Fishwick G, Naylor R, Bell PR (2002) Subintimal angioplasty of isolated infragenicular vessels in lower limb ischemia:long-term results. J Endovasc Ther 9:411–416PubMedCrossRef
7.
Zurück zum Zitat Matsi PJ, Manninen HI, Suhonen MT, Pirinen AE, Soimakallio S (1993) Chronic critical lower-limb ischemia: prospective trial of angioplasty with 1–36 months follow–up. Radiology 188:381–387PubMed Matsi PJ, Manninen HI, Suhonen MT, Pirinen AE, Soimakallio S (1993) Chronic critical lower-limb ischemia: prospective trial of angioplasty with 1–36 months follow–up. Radiology 188:381–387PubMed
8.
Zurück zum Zitat Söder HK, Manninen HI, Jaakkola P, Matsi PJ, Räsänen HT, Kaukanen E et al (2000) Prospective trial of infrapopliteal artery balloon angioplasty for critical limb ischemia: angiographic and clinical results. J Vasc Inter Radiol 11:1021–1031CrossRef Söder HK, Manninen HI, Jaakkola P, Matsi PJ, Räsänen HT, Kaukanen E et al (2000) Prospective trial of infrapopliteal artery balloon angioplasty for critical limb ischemia: angiographic and clinical results. J Vasc Inter Radiol 11:1021–1031CrossRef
9.
Zurück zum Zitat Bailey CM, Saha S, Magee TR, Galland RB (2003) A 1 year prospective study of management and outcome of patients presenting with critical lower limb ischaemia. Eur J Vasc Endovasc Surg 25:131–134PubMedCrossRef Bailey CM, Saha S, Magee TR, Galland RB (2003) A 1 year prospective study of management and outcome of patients presenting with critical lower limb ischaemia. Eur J Vasc Endovasc Surg 25:131–134PubMedCrossRef
10.
Zurück zum Zitat Bosiers M, Deloose K, Verbist J, Peeters P (2006) Percutaneous transluminal angiplasty for treatmentof below-the-knee critical limb ischemia. Early autcomes following the use of sirolimus-eluting stents. J Cardiovasc Surg 47:171–176 Bosiers M, Deloose K, Verbist J, Peeters P (2006) Percutaneous transluminal angiplasty for treatmentof below-the-knee critical limb ischemia. Early autcomes following the use of sirolimus-eluting stents. J Cardiovasc Surg 47:171–176
11.
12.
Zurück zum Zitat Dorros G, Jaff MR, Dorros AM, Mathiak LM, He T (2001) Tibioperoneal (outflow lesion) angioplasty can be used as primary treatment in 235 patients with critical limb ischemia. Circulation 104:2057–2206PubMedCrossRef Dorros G, Jaff MR, Dorros AM, Mathiak LM, He T (2001) Tibioperoneal (outflow lesion) angioplasty can be used as primary treatment in 235 patients with critical limb ischemia. Circulation 104:2057–2206PubMedCrossRef
13.
Zurück zum Zitat Duda SH, Pusich B, Richter G, Landwehr P, Oliva VL, Tielbeek A et al (2002) Sirolimus eluting stents for the treatment of obstructive superfical femoral artery disease: 6-months results. Circulation 106:1505–1509PubMedCrossRef Duda SH, Pusich B, Richter G, Landwehr P, Oliva VL, Tielbeek A et al (2002) Sirolimus eluting stents for the treatment of obstructive superfical femoral artery disease: 6-months results. Circulation 106:1505–1509PubMedCrossRef
14.
Zurück zum Zitat Löfberg AM, Lörelius LE, Karacagil S, Westman B, Almgren B, Bergqvist D (1996) The use of below-knee percutaneous transluminal angioplasty in arterial occlusive disease causing chronic critical limb ischemia. Cardiovasc Intervent Radiol 19:317–322PubMedCrossRef Löfberg AM, Lörelius LE, Karacagil S, Westman B, Almgren B, Bergqvist D (1996) The use of below-knee percutaneous transluminal angioplasty in arterial occlusive disease causing chronic critical limb ischemia. Cardiovasc Intervent Radiol 19:317–322PubMedCrossRef
15.
Zurück zum Zitat Krankenberg H, Sorge I, Zeller T, Tübler T (2005) Percutaneous transluminal angioplasty of infrapopliteal arteries in patients with intermittent claudication: acute and 1-year results. Catheter Cardiovasc Interv 64:12–17PubMedCrossRef Krankenberg H, Sorge I, Zeller T, Tübler T (2005) Percutaneous transluminal angioplasty of infrapopliteal arteries in patients with intermittent claudication: acute and 1-year results. Catheter Cardiovasc Interv 64:12–17PubMedCrossRef
16.
Zurück zum Zitat Feiring AJ, Wesolowski AA, Lade S (2004) Primary stent-supported angioplasty for testment of below-knee critical limb ischemia and severe claudication. Am Coll Cardiol 44:2307–2314CrossRef Feiring AJ, Wesolowski AA, Lade S (2004) Primary stent-supported angioplasty for testment of below-knee critical limb ischemia and severe claudication. Am Coll Cardiol 44:2307–2314CrossRef
17.
Zurück zum Zitat Bull PG, Mendel H, Hold M, Schlegl A, Denck H (1992) Distal popliteal and tibioperoneal transluminal angioplasty: long-term follow-up. J Vasc Interv Radiol 3:45–53PubMedCrossRef Bull PG, Mendel H, Hold M, Schlegl A, Denck H (1992) Distal popliteal and tibioperoneal transluminal angioplasty: long-term follow-up. J Vasc Interv Radiol 3:45–53PubMedCrossRef
18.
Zurück zum Zitat Siablis D, Karnabatidis D, Katsanos K, Kagadis GC, Kraniotis P, Diamantopoulos A et al (2007) Sirolimus-eluting versus bare stents after suboptimal infrapopliteal angioplasty for critical limbischemia: enduring 1-year angiographic and clinical benefit. J Endovasc Ther 14:241–250PubMedCrossRef Siablis D, Karnabatidis D, Katsanos K, Kagadis GC, Kraniotis P, Diamantopoulos A et al (2007) Sirolimus-eluting versus bare stents after suboptimal infrapopliteal angioplasty for critical limbischemia: enduring 1-year angiographic and clinical benefit. J Endovasc Ther 14:241–250PubMedCrossRef
19.
Zurück zum Zitat Scheinert D, Ulrich M, Scheinert S, Sax J, Braunlich S, Biamino G et al (2006) Comparison of sirolimus-eluting vs bare-metal stents for the treatment of infrapopliteal obstructions. EuroIntervention 2:169–174 Scheinert D, Ulrich M, Scheinert S, Sax J, Braunlich S, Biamino G et al (2006) Comparison of sirolimus-eluting vs bare-metal stents for the treatment of infrapopliteal obstructions. EuroIntervention 2:169–174
20.
Zurück zum Zitat Kimura T, Yokoi H, Nakagawa Y, Tamura T, Kaburagi S, Sawada J (1996) Three-year follow-up after implantation of metallic coronary-artery stents. N Engl J Med 334:561–566PubMedCrossRef Kimura T, Yokoi H, Nakagawa Y, Tamura T, Kaburagi S, Sawada J (1996) Three-year follow-up after implantation of metallic coronary-artery stents. N Engl J Med 334:561–566PubMedCrossRef
21.
Zurück zum Zitat Klugherz BD, DeAngelo DL, Kim BK, Herrmann HC, Hirshfeld JW, Kolansky DM (1996) Three-year clincal follow-up after Palmaz-Schatz stenting. J Am Coll Cardiol 27:1185–1191PubMedCrossRef Klugherz BD, DeAngelo DL, Kim BK, Herrmann HC, Hirshfeld JW, Kolansky DM (1996) Three-year clincal follow-up after Palmaz-Schatz stenting. J Am Coll Cardiol 27:1185–1191PubMedCrossRef
22.
Zurück zum Zitat Mauri L, Orav EJ, Kuntz RE (2005) Late loss in lumen diameter and binary restenosis for drug-eluting stent comparison. Circulation 111:3435–3442PubMedCrossRef Mauri L, Orav EJ, Kuntz RE (2005) Late loss in lumen diameter and binary restenosis for drug-eluting stent comparison. Circulation 111:3435–3442PubMedCrossRef
23.
Zurück zum Zitat Mauri L, Orav EJ, Candia SC, Cutlip DE, Kuntz RE (2005) Robustness of late lumen loss in discriminating drug-eluting stents across variable observational and randomized trials. Circulation 112:2833–2839PubMedCrossRef Mauri L, Orav EJ, Candia SC, Cutlip DE, Kuntz RE (2005) Robustness of late lumen loss in discriminating drug-eluting stents across variable observational and randomized trials. Circulation 112:2833–2839PubMedCrossRef
24.
Zurück zum Zitat Shiran A, Mintz GS, Waksman R, Mehran R, Abizaid A, Kent KM et al (1998) Early lumen loss afler treatment of in-stent restenosis. Circulation 98:200–203PubMed Shiran A, Mintz GS, Waksman R, Mehran R, Abizaid A, Kent KM et al (1998) Early lumen loss afler treatment of in-stent restenosis. Circulation 98:200–203PubMed
25.
Zurück zum Zitat Hoffmann R, Mintz GS (2000) Coronary in-stent restenosis – predictors, treatment and prevention. Eur Heart J 21:1739–1749PubMedCrossRef Hoffmann R, Mintz GS (2000) Coronary in-stent restenosis – predictors, treatment and prevention. Eur Heart J 21:1739–1749PubMedCrossRef
26.
Zurück zum Zitat Danielsson G, Albrechtsson U, Norgren L, Danielsson P, Ribbe E, Thörne J et al (2001) Percutaneous transluminal angioplasty of crural arteries: diabetes and other factors influencing outcome. Eur J Vasc Endovasc Surg 21:432–436PubMedCrossRef Danielsson G, Albrechtsson U, Norgren L, Danielsson P, Ribbe E, Thörne J et al (2001) Percutaneous transluminal angioplasty of crural arteries: diabetes and other factors influencing outcome. Eur J Vasc Endovasc Surg 21:432–436PubMedCrossRef
27.
Zurück zum Zitat Mlekusch W, Schillinger M, Sabeti S, Maca T, Ahmadi R, Minar E (2002) Clinical outcome and prognostic factors for ischaemic ulcers treated with PTA in lower limbs. Eur J Vasc Endovasc Surg 24:176–181PubMedCrossRef Mlekusch W, Schillinger M, Sabeti S, Maca T, Ahmadi R, Minar E (2002) Clinical outcome and prognostic factors for ischaemic ulcers treated with PTA in lower limbs. Eur J Vasc Endovasc Surg 24:176–181PubMedCrossRef
28.
Zurück zum Zitat Criqui MH, Langer RD, Fronek A, Feigelson HS, Klauber MR, McCann TJ et al (1992) Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 326:381–386PubMed Criqui MH, Langer RD, Fronek A, Feigelson HS, Klauber MR, McCann TJ et al (1992) Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 326:381–386PubMed
29.
Zurück zum Zitat Belli AM, Cumberland DC, Knox AM, Procter AE, Welsh CL (1990) The complication rate of percutaneous peripheral balloon angioplasty. Clin Radiol 41:380–283PubMedCrossRef Belli AM, Cumberland DC, Knox AM, Procter AE, Welsh CL (1990) The complication rate of percutaneous peripheral balloon angioplasty. Clin Radiol 41:380–283PubMedCrossRef
Metadaten
Titel
The evaluation of primary stenting of sirolimus-eluting versus bare-metal stents in the treatment of atherosclerotic lesions of crural arteries
verfasst von
Aleksander Falkowski
Wojciech Poncyljusz
Grażyna Wilk
Małgorzata Szczerbo-Trojanowska
Publikationsdatum
01.04.2009
Verlag
Springer-Verlag
Erschienen in
European Radiology / Ausgabe 4/2009
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-008-1225-1

Weitere Artikel der Ausgabe 4/2009

European Radiology 4/2009 Zur Ausgabe

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.