Covered Balloon Expandable Stents Research Articles

Polytetrafluoroethylene Covered Stent Placement for Focal Occlusive Disease of the Infrarenal Aorta

Arterial insufficiency is rarely caused by isolated infrarenal aortic occlusive lesions. Endovascular treatment options include plain balloon angioplasty and bare metal stent placement. In this study the feasibility and efficacy of polytetrafluoroethylene (PTFE) covered balloon expandable stents were evaluated. Consecutive patients from two centers were prospectively collected in a database and retrospectively analyzed. Results were evaluated by clinical examination, ankle-brachial indices (ABI), duplex ultrasound, and plain abdominal radiography. Thirty-six consecutive patients were treated between November 2008 and June 2013. Indication for treatment was Rutherford 3 (n = 29), 4 (n = 3), and 5 (n = 4). Technical success was always achieved and there were no distal embolizations or vessel wall ruptures. The median follow-up was 22 months (range 0–60). All patients improved clinically and the ABI increased significantly from 0.73 ± 0.18 to 1.01 ± 0.14 (p < .01). One patent covered stent was removed surgically because of infection. Primary patency rates were 100% at 1 and 2 years without stent fractures. The use of PTFE covered stents for the treatment of isolated infrarenal aortic occlusive disease is safe and very effective. Patency rates are excellent and complications including distal embolization and vessel wall rupture are extremely rare.

Polytetrafluoroethylene Covered Stent Placement for Focal Occlusive Disease of the Infrarenal Aorta

Arterial insufficiency is rarely caused by isolated infrarenal aortic occlusive lesions. Endovascular treatment options include plain balloon angioplasty and bare metal stent placement. In this study the feasibility and efficacy of polytetrafluoroethylene (PTFE) covered balloon expandable stents were evaluated. Consecutive patients from two centers were prospectively collected in a database and retrospectively analyzed. Results were evaluated by clinical examination, ankle-brachial indices (ABI), duplex ultrasound, and plain abdominal radiography. Thirty-six consecutive patients were treated between November 2008 and June 2013. Indication for treatment was Rutherford 3 (n = 29), 4 (n = 3), and 5 (n = 4). Technical success was always achieved and there were no distal embolizations or vessel wall ruptures. The median follow-up was 22 months (range 0-60). All patients improved clinically and the ABI increased significantly from 0.73 ± 0.18 to 1.01 ± 0.14 (p < .01). One patent covered stent was removed surgically because of infection. Primary patency rates were 100% at 1 and 2 years without stent fractures. The use of PTFE covered stents for the treatment of isolated infrarenal aortic occlusive disease is safe and very effective. Patency rates are excellent and complications including distal embolization and vessel wall rupture are extremely rare.

Outcomes of covered versus bare-metal balloon-expandable stents for aortoiliac occlusive disease

Randomized trials and retrospective data suggest that covered balloon-expandable (CBE) stents have better short-term patency compared with balloon-expandable bare-metal stents (BMSs) in the treatment of iliac artery disease. This study evaluated midterm outcomes of BMSs vs CBE stents placed in the common iliac artery (CIA) for aortoiliac occlusive disease. All endovascular interventions for symptomatic peripheral arterial occlusive disease performed at a single institution from 2006 to 2012 were reviewed. Patients undergoing stent placement in the CIA segment were included in the analysis. Demographic data, TransAtlantic Inter-Society Consensus (TASC) classification, stent type, patency, and limb reinterventions were compared. For treatment of de novo distal aorta or CIA stenosis, 254 procedures were performed in 162 patients. BMSs were used in 190 arteries; CBE stents were used in 64 arteries. There was no difference in age, gender, or TASC classification between the two groups. Mean follow-up was 22 ± 16 months. Primary patency, assisted patency, and secondary patency were significantly better in the BMS group. CIAs treated with covered stents were more likely at 1 year or longer to require repeated intervention (hazard ratio, 2.5; 95% confidence interval, 1.2-5.3; P = .009). TASC classification did not predict need for reintervention in either group. Multivariate analysis revealed dual antiplatelet therapy to be the only other factor to affect patency during long-term follow-up. In this study, BMSs had significantly better patency compared with CBE stents for treatment of aortoiliac occlusive disease. A randomized trial comparing patency as well as restenosis rates with long-term follow-up is needed to determine if there is any benefit from use of covered stents in the aortoiliac segment.

TCT-543 Covered Endovascular Reconstruction of Aortic Bifurcation or CERAB-technique for treating extensive aortoiliac occlusive disease.

We developed the Covered Endovascular Reconstruction of Aortic Bifurcation or CERAB-technique for extensive and/or recurrent aortoiliac occlusive disease using V12 covered balloon expandable stents (Atrium Maquet Getinge Europe BV) to rebuild the aortic bifurcation. Endovascular bifemoral

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

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

Abstract No. 281 EE: Unique Applications of the Balloon Expandable Covered Stent in a Wide Variety of Vascular Territories

To demonstrate various patterns of vascular pathology in multiple vascular territories as seen on CT, MR, and conventional angiography and demonstrate how they can be successfully treated with novel and unique applications of the balloon expandable covered stent.