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Provisional stenting may be preferable for popliteal artery lesions
A prospective, randomized, multicenter trial concluded that provisional stenting as part of a balloon angioplasty strategy had equivalent 1-year patency and should be preferred over primary stenting for the treatment of popliteal artery lesions.
The study compared 246 patients at nine centers in the ETAP study. The intervention consisted of primary nitinol stent placement or percutaneous transluminal balloon angioplasty (PTA) in patients with peripheral artery disease Rutherford-Becker class 2 to 5 who had a de novo lesion in the popliteal artery.
Among the 197 patients available for 1-year follow-up, the 1-year primary patency rate was significantly higher in the nitinol stent group than in the balloon angioplasty group (67.4% vs. 44.9%; P=.002) and target lesion revascularization rates were significantly lower (14.7% vs. 44.1%; P=.0001). However, when provisional nitinol stent placement was not considered, there were no significant differences between the study groups (67.4% vs. 65.7%; P=.92 for primary patency). Additionally, patients in the PTA and nitinol stent groups showed similar rates of improvement of at least one Rutherford-Becker class (73% vs. 77%; P=.31).
“This difference is exclusively driven by intra-procedural cross-over from the [PTA] arm to stent placement that was classified as [the] primary endpoint and TLR,” the researchers wrote. “After the initial procedure, however, no significant differences concerning the primary endpoint and TLR could be observed between the study groups as shown by the intention-to-treat analysis and the ‘treatment received’ analysis.”
Disclosure: The researchers report no relevant financial disclosures.