Covered Stents Versus Uncovered Stents in the Treatment of Supra-Aortic Trunks Occlusive Disease

Abstract

Introduction - Published reports on endovascular treatment of supra-aortic trunks occlusive disease (SATOD) are relatively scarce, with a limited numbers of cases1. Results still show a high rate of restenosis1-5 that could possibly be improved by the use of covered stents. To our knowledge, no study has been published to evaluate the use of covered stents in this location. The aim of our study is to compare the rate of restenosis and patency after endovascular treatment of SATOD using covered stents (CS) versus uncovered stents (UCS). Methods - This was a retrospective study compiling consecutive cases of stenting angioplasty for SATOD performed between July 2008 and January 2017 in our academic institution. We defined 2 groups: CS and UCS depending on the type of stent we used. Demographic characteristics, clinical presentations, procedures details and outcomes were recorded. We considered all restenosis when higher than 50%. Results - Sixty-two supra-aortic trunks were treated in 54 patients. Twenty-nine cases were included in Group CS and 33 in Group UCS. Mean age was 65.8 ± 1.4 [38.8 - 86.5] years. The lesions treated were the left subclavian artery (n=32, 51.6%), the brachiocephalic artery (n=16, 25.8%), the right subclavian artery (n=10, 16.1%) and the left common carotid artery (n=5, 8.1%). Thirty-seven (59.7%) lesions were symptomatic and seven (11.3%) were occlusions. The mean follow-up was 27.6 ± 3.1 [0.03 - 103.1] months. Only 2 patients (3.2%) with one lesion each were lost to follow-up. The characteristics of the patients were comparable between both groups in terms of age, sex and type of lesions. The average time of restenosis was 23.4 ± 4.4 [0.1 - 54.1] months. The overall restenosis rate was 6.9% in Group CS and 36.4% in Group UCS (p = 0.006). Tight restenosis (greater than 70%) rate was 6.9% in Group CS and 12.1% in Group UCS (p = NS). Survival without restenosis was 85.9% and 82.1% at 2 years and 85.9% and 72.6% at 3 years in Group CS and Group UCS respectively (p = NS). The primary and secondary patency rates at 2 years were 100% in Group CS and 96.9% in Group UCS (p = NS). Conclusion - Compared to UCS, CS appears to have an advantage in term of restenosis for the treatment of SATOD. However, short and mid-term patency was comparable between these two kinds of stent. Further randomized studies should be proposed.