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DCBs help prevent edge stenosis after stent grafting in SFA occlusions
The use of a drug-coated balloon after stent graft treatment of superficial femoral artery occlusive disease reduced risk for edge stenosis, decreased target lesion revascularization and improved primary patency, researchers reported.
The researchers analyzed 110 patients (mean age, 73 years; 78 men) with long superficial femoral artery (SFA) occlusions who were treated with a covered stent graft (Viabahn, W.L. Gore & Associates) between October 2011 and July 2016. Among the cohort, 34.5% had reinforcement with a DCB at the distal edge of the stent graft.
According to the study background, edge stenosis is caused by neointimal hyperplasia and results in lumen thrombosis, the primary cause of failure of the stent graft.
Patients were stratified by whether they had edge stenosis (n = 22) or not (n = 88).
Compared with those without edge stenosis, patients with edge stenosis were more likely to have diabetes (P = .008) and to need retrograde access (P = .033), but otherwise clinical and procedural characteristics were similar between the groups, Ting-Chao Lin, MD, from the division of cardiovascular surgery at Cheng Hsin General Hospital and the department of medicine at National Yang-Ming University, both in Taipei, Taiwan, and colleagues wrote.
Compared with those who did not have DCB reinforcement, those who had it were less likely to get edge stenosis (P = .021), had less TLR at 1 year (P = .01) and had a higher primary patency rate at 1 year (92.1% vs. 76.4%; P = .042), according to the researchers.
When the researchers conducted a multivariate analysis, they found the only independent predictor of edge stenosis was poor distal runoff (OR = 0.31; 95% CI, 0.11-0.83).
“Poor distal runoff was a predisposing factor for the development of edge stenosis after Viabahn implantation to treat long SFA occlusions,” the researchers wrote. “DCB reinforcement over the distal Viabahn edge may prevent edge stenosis, resulting in fewer TLRs and superior primary patency at 1 year vs. Viabahn implantation alone.” – by Erik Swain
Disclosure s : The authors report no relevant financial disclosures.