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Subintimal, intraluminal DES yield similar 2-year restenosis rates in femoropopliteal CTO
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In patients with femoropopliteal chronic total occlusion, subintimal and intraluminal drug-eluting stent implantation appears to yield similar 2-year restenosis rates, according to recent findings.
In the subanalysis of the prospective, multicenter ZEPHYR trial, researchers evaluated 192 lesions in 176 patients (mean age, 74 years; 130 men) enrolled in the trial. Lesions eligible for inclusion were de novo CTOs with available data on wire crossing.
The researchers used IVUS to visualize the vessel lumen immediately after successful guidewire crossing to determine the crossing plane. Intraluminal crossing was defined as wire passage inside plaque and subintimal crossing was defined as crossing between the plaque and the media. Calcification was identified on fluoroscopy. The primary outcome was the rate of 2-year restenosis as evaluated by duplex ultrasonography or follow-up angiography with a window of ± 2 months. The researchers defined restenosis as identification of 50% diameter stenosis on angiography or a peak systolic velocity ratio > 2.4 by duplex ultrasonography. Major adverse limb events and major amputation were also defined as restenosis. Secondary outcome measures included 2-year rates of major adverse limb events, occlusion and stent thrombosis.
In a comparison of primary patency between subgroups with and without subintimal wire passage, the researchers used propensity score matching to minimize differences between groups in baseline characteristics. Propensity score matching extracted 61 matched pairs (mean age, 75 years; 49 men) with no significant differences between groups in baseline characteristics.
femoropopliteal CTOs (38%). The 1-year restenosis rates were 45% (95% CI, 32-59) in the subintimal DES implantation group and 35% (95% CI, 22-49) in the intraluminal DES implantation group (P = .352). Nor was there a significant difference at 2 years (subintimal DES group, 56%; 95% CI, 41-71; intraluminal DES group, 51%; 95% CI, 34-68; P = .648). Moreover, no significant intergroup differences were seen in terms of major adverse limb events, occlusion or risk for stent thrombosis.
The subintimal DES group had a 5% (95% CI, 0-11) rate of perioperative vascular complications vs. a rate of 3% (95% CI, 0-8) in the intraluminal DES group (P = .824).
No significant interaction effect was seen in terms of baseline characteristics and the association of subintimal angioplasty and restenosis risk.
[endovascular therapy] strategy regardless of patient, lesion or procedure characteristics.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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