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DES reduced amputation rate for patients with critical limb ischemia
Use of drug-eluting stents after suboptimal percutaneous transluminal angioplasty for the treatment of infrapopliteal arterial disease in patients with critical limb ischemia was associated with high primary patency and reduced amputation rates.
Results of a retrospective review of a single-center study of patients with critical limb ischemia were presented at the Society of Interventional Radiology’s Scientific Meeting.
Researchers studied 107 patients (Rutherford grade 4, 5 and 6) with critical limb ischemia who underwent percutaneous transluminal angioplasty between October 2005 and October 2012. The patients had suboptimal angiographic results immediately following percutaneous transluminal angioplasty and were subsequently treated with drug-eluting stents.
In total, 171 stents (106 sirolimus, 62 everolimus, three paclitaxel) were placed in the patients to treat 143 angiographic lesions. Simultaneous femoral-popliteal intervention was performed in 71% of patients. Forty-one percent of the treated lesions were total occlusions. Lesion length ranged from 13 mm to 147 mm; mean length was 52 mm.
Robert A. Lookstein
Initial technical success was 100%. All 143 lesions were treated successfully, with less than 10% stenosis after implantation.
Mean follow-up was 25 months. The primary patency rate was 92% at 6 months, 84% at 12 months and 70% at 24 months. Freedom from major amputation was 89%. All of the 12 major amputations occurred in the Rutherford grade 6 group. The overall mortality rate was 21%; one death occurred within 30 days, according to the study abstract.
“Many peripheral arterial disease patients are not candidates for surgery and are seeking minimally invasive options. This therapy is an emerging technology that is safe and effective for treating critical limb ischemia,” Robert A. Lookstein, MD, FSIR, chief of interventional radiology at Mount Sinai Medical Center, said in a press release. “This study shows that this technology is superior to balloon angioplasty and rivals the results of surgical bypass. It’s safe, it’s durable and the outcomes are spectacular. The vast majority of patients were able to avoid amputation and dramatically improve their quality of life.”
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Disclosure: Lookstein reports consulting for Bayer Interventional, Boston Scientific and Cordis. The other researchers report no relevant financial disclosures.