EVISTA-DVT: Stents for deep vein thrombosis had better outcomes than balloons alone

Society for Cardiovascular Angiography and Interventions 2011 Scientific Sessions

BALTIMORE — Stenting had superior outcomes to balloons alone in deep vein thrombosis patients, according to new late-breaking clinical trial results.

Lead investigator Mohsen Sharifi, MD, director of Arizona Cardiovascular Consultants, told attendees that the results of the Endovenous Infra-inguinal Stenting and Angioplasty in Deep Venous Thrombosis Trial (EVISTA-DVT) were “encouraging.” In a press release, Sharifi said, “For patients with [deep vein thrombosis], stenting is a viable option, as demonstrated by the success rates for patients studied in this trial.”

The trial, which included 141 patients with high-grade residual stenosis >70% and anticoagulant medical refractory, gathered efficacy and safety data on stents placed in the femoral popliteal veins in deep vein thrombosis (DVT) patients. Patients were randomly assigned to receive either a stent (n=71) or balloon venoplasty alone (n=70).

Every 6 months — sooner if patients were symptomatic — patients underwent venous duplex scanning; follow-up lasted, on average, 35 months. Patients suspected to have redeveloped DVT had repeat venography with ultrasound evaluation. Six patients in the stent group and 15 in the control group underwent subsequent venography and ultrasound; of these, DVT was found in 4% and 7%, respectively. Investigators also found the patency of the treated vein was higher in the stent group than in the control group.

Investigators found that DVT was asymptomatic in most patients in the stent group and mildly symptomatic in the control group. The mechanism of stent thrombosis was thrombosis extension and venosclerosis-induced external compression. There was no neointimal proliferation as the cause of stent stenosis; in addition, there were no stent fractures, extrusion or perforation.

“Stent thrombosis occurs in 4% of cases and is not due to neointimal proliferation,” Sharifi said in his abstract. “It does not occur independently and is usually an extension of DVT in the adjacent venous segments with high-grade stenosis (inflow or outflow obstruction). External compression is an important factor in preventing full-stent expansion, which is seen in extensive venosclerosis. Stenting is superior to balloon venoplasty alone.”

Disclosure: Dr. Sharifi reports no relevant financial disclosures.

For more information:

Sharifi M. LBCT II. Presented at: Society of Cardiovascular Angiography and Interventions Scientific Sessions; May 4-7, 2011; Baltimore.

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