Midterm Outcomes of Covered Versus Bare-Metal Balloon-Expandable Stents for Aortoiliac Occlusive Disease

Abstract

Randomized trials and registries suggest that covered balloon expandable stents have better short-term patency than bare metal (BM) balloon expandable stents in the treatment of common iliac artery disease. This study was performed to evaluate midterm outcomes of bare metal vs covered balloon expandable stents for treatment of aortoiliac (AI) occlusive disease. All AI endovascular interventions for symptomatic peripheral arterial occlusive disease performed at a single institution from 2006-2012 were reviewed. Patients that underwent stent placement in the common iliac arterial segment were included in the analysis. Demographic data, TransAtlantic Inter-Societal Classification (TASC), stent type, patency, and all reinterventions for each limb were compared. 188 procedures in 124 patients were performed for treatment of de novo distal aorta and/or common iliac artery stenosis. Bare metal balloon expandable stents were used in 135 arteries, and covered balloon expandable stents were used in 53 arteries. There was no difference in age, gender, or TASC classification between the two groups. Table I. Median follow up was 1.7 years (IQR, 0.6-3.0). There was no difference in overall primary or primary assisted patency between the two groups. Table II. Secondary patency was significantly better in the covered stent group, however, common Iliac arteries treated with covered stents were more likely at 1 year and beyond to require repeat aortoiliac intervention (HR, 2.6; 95% CI, 1.13-6.0; P = .02; Fig). TASC classification did not predict need for reintervention in either group. In the current study, covered stents have improved secondary patency over bare metal stents for treatment of AI occlusive disease, at the expense of increased reinterventions. The difference in secondary patency may be due to more focal, edge restenosis in covered stents vs diffuse restenosis in bare metal stents.Table IDemographic characteristics of treated lesionsOverallBare metalCoveredP valueAge (mean ± SD)64 ± 1164 ± 1265 ± 11.5TASC A (%)54 (45)39 (43)15 (52).57TASC B56 (30)41 (30)15 (28).99TASC C41 (22)30 (22)11 (21).98TASC D36 (19)24 (18)12 (23).58 Open table in a new tab Table IIPatency of treated lesionsn = 188OverallBare metalCoveredP valuePrimary patency (%)121 (75)86 (75)35 (74).99Primary assisted patency136 (84)93 (82)43 (91).18Secondary patency140 (87)94 (82)46 (98).02 Open table in a new tab