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DES may be option to treat long femoropopliteal lesions
Use of a drug-eluting stent to treat long femoropopliteal lesions appears to be effective, but more restenosis and reinterventions were observed compared with those who had shorter femoropopliteal lesions treated with the DES, researchers reported.
The researchers performed a retrospective review of 89 consecutive patients (mean age, 69 years; 86 men) with femoropopliteal disease (mean lesion length, 24.2 cm) treated with the DES (Zilver PTX, Cook Medical).
Patients were stratified by lesion length: 41 with lesions 20 cm or less were compared with 48 with lesions more than 20 cm.
The primary endpoints were duplex-derived restenosis, defined as peak systolic velocity ratio greater than 2.5, clinically driven reintervention and major amputation.
Restenosis occurred less often in the shorter-lesion group vs. the longer-lesion group at 1 year (19% vs. 40%; P = .05) and at 2 years (39% vs. 54%; P = .331), John A. Phillips, MD, from OhioHealth Heart and Vascular Physicians in Columbus, and colleagues found.
Reintervention rates were lower in the shorter-lesion group at 1 year (2% vs. 21%; P = .009) and 2 years (12% vs. 33%; P = .019), according to the researchers.
Each group had one amputation and neither was related to the procedure.
“Given the fact that the [superficial femoral artery] is the longest artery in the body and is subject to constant torsion and compression, it is logical that the longer the extent of atherosclerotic disease, the higher the likelihood of restenosis and reintervention,” Phillips and colleagues wrote. “The 67% freedom from reintervention ultimately illustrates that the use of Zilver PTX in lesions > 20 cm is both feasible and a clinically effective treatment for these patients with lifestyle-limiting peripheral artery disease. Head-to-head trials of drug-based endovascular technology are needed in complex [femoropopliteal] disease.” – by Erik Swain
Disclosures: Phillips reports he is a consultant for Cook Medical. Another author reports he is a consultant for and receives royalties from Cook Medical.