SS14. Comparison of Covered Stents versus Bare Metal Stents for Treatment of Chronic Atherosclerotic Mesenteric Arterial Disease

The use of drug-coated devices in intravascular therapy is aimed at preventing neointimal hyperplasia caused by excessive proliferation of vascular smooth muscle and thereby restenosis. Although its use seemed initially promising, a recent publication has shown an increased risk of mortality with paclitaxel-coated devices, and there is an urgent need to reaffirm assessments of drug-eluting stents (DES). Objective: The aim of the study was to compare mortality and effectiveness of paclitaxel-coated stents and bare-metal stents (BMS) in the treatment of peripheral arterial disease (PAD) with long-term follow-up. Materials and methods: In a single center randomized study, 256 patients with PAD were treated intravascularly with stent implantation. Patients were randomized into two groups: the first (n = 126) were treated with DES, and the second (n = 130) were treated with BMS. The study included evaluation after the procedure, after about 6 months and 36 months. Co-morbidities, with risks for atherosclerosis, were analyzed in all patients. Patients were evaluated for clinical outcome, restenosis frequency, and safety (complications and total mortality). Results: Clinical benefit at the end of the investigation was statistically significantly better in the DES group compared with the BMS group: 85.7% versus 66.2% (p = 0.0003), respectively. Restenosis occurred significantly less frequently in patients with DES: 16.0% versus BMS: 35.0%, p = 0.012. There was no significant effect of comorbidities on the frequency of restenoses. There were no differences in all-cause mortality over the three years with paclitaxel and no-paclitaxel stents cohorts (8.7% versus 7.1%; long-rank p = 0.575). No association was found with mortality and treatment with DES or BMS. Conclusions: The use of paclitaxel-coated stents gave good clinical benefit and caused a significantly lower frequency of restenosis compared to bare-metal stents. The use of paclitaxel-coated stents did not increase mortality.

Download Full-text

Stenting across head and neck vessels using covered stents for persisting aortic arch obstruction

Cardiology in the Young ◽

10.1017/s1047951112000236 ◽

2012 ◽

Vol 22 (5) ◽

pp. 610-614 ◽

Cited By ~ 3

Author(s):

James R. Bentham ◽

Nilesh Oswal ◽

Robert Yates

Keyword(s):

Head And Neck ◽

Aortic Arch ◽

Stent Placement ◽

Bare Metal Stents ◽

Coarctation Of The Aorta ◽

Metal Stents ◽

Covered Stents ◽

Bare Metal ◽

Endovascular Stent ◽

Endovascular Stent Placement

AbstractObjectiveTo describe endovascular stent placement using partially covered stents to preserve flow in head and neck vessels.BackgroundEndovascular stent placement has become established as a first-line therapy for native coarctation of the aorta or re-coarctation in older children and adults. Increasingly covered stents are becoming the preferred option over bare-metal stents because of the perceived lower risk of aneurysm formation. Open-cell bare-metal stents are chosen when there is a high likelihood of jailing a head and neck vessel. Here we describe partial uncovering of a covered stent before implantation to allow flow through the uncovered portion of the stent to the branch vessel but preserve the covering over the majority of the remaining stent.MethodsWe describe two cases with aortic arch hypoplasia and re-coarctation, both of which required two partially uncovered stents for a satisfactory result.ConclusionsEndovascular stent placement is becoming the preferred option in the management of coarctation of the aorta in older children and adults. Strategies to deal with transverse arch hypoplasia and multiple levels of aortic arch obstruction frequently involving branch vessels or aneurysms need to be considered before these procedures are embarked upon. Partially uncovering stents may afford more protection than using bare-metal stents in the transverse and distal arch while preserving flow in head and neck branches, and is a technically straightforward procedure.

Download Full-text

5-Year Follow-Up of Polytetrafluoroethylene-Covered Stents Compared With Bare-Metal Stents in Aortocoronary Saphenous Vein Grafts

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2010.11.013 ◽

2011 ◽

Vol 4 (3) ◽

pp. 300-309 ◽

Cited By ~ 49

Author(s):

Gregg W. Stone ◽

Sheldon Goldberg ◽

Charles O'Shaughnessy ◽

Mark Midei ◽

Robert M. Siegel ◽

...

Keyword(s):

Saphenous Vein ◽

Bare Metal Stents ◽

Metal Stents ◽

Covered Stents ◽

Bare Metal ◽

Vein Grafts ◽

Saphenous Vein Grafts

Download Full-text

Superior Patency of Covered Stents Over Bare Metal Stents in Patients with Chronic Mesenteric Ischemia

Journal of Vascular Surgery ◽

10.1016/j.jvs.2010.11.090 ◽

2011 ◽

Vol 53 (2) ◽

pp. 559 ◽

Cited By ~ 4

Author(s):

Luke Erdoes ◽

Heather Mixon ◽

Christopher Lesar ◽

Denny Schoch

Keyword(s):

Mesenteric Ischemia ◽

Bare Metal Stents ◽

Metal Stents ◽

Covered Stents ◽

Chronic Mesenteric Ischemia ◽

Bare Metal

Download Full-text

Patients with Failed Femoropopliteal Covered Stents are More Likely to Present with Acute Limb Ischemia than Those with Failed Femoropopliteal Bare-Metal Stents

Journal of Vascular Surgery ◽

10.1016/j.jvs.2021.01.029 ◽

2021 ◽

Author(s):

Charles DeCarlo ◽

Laura T. Boitano ◽

Chris A. Latz ◽

C.Y. Maximilian Png ◽

Sujin Lee ◽

...

Keyword(s):

Bare Metal Stents ◽

Limb Ischemia ◽

Metal Stents ◽

Covered Stents ◽

Acute Limb Ischemia ◽

Bare Metal

Download Full-text

Lower Rate of Restenosis and Reinterventions With Covered vs Bare Metal Stents Following Innominate Artery Stenting

Journal of Endovascular Therapy ◽

10.1177/1526602819838867 ◽

2019 ◽

Vol 26 (3) ◽

pp. 385-390 ◽

Cited By ~ 5

Author(s):

Myriam Ammi ◽

Samir Henni ◽

Lucie Salomon Du Mont ◽

Nicla Settembre ◽

Hélène Loubiere ◽

...

Keyword(s):

Bare Metal Stents ◽

Innominate Artery ◽

Symptomatic Patient ◽

Artery Stenosis ◽

Metal Stents ◽

Covered Stents ◽

Bare Metal ◽

University Hospitals ◽

Relative Risks ◽

Innominate Artery Stenosis

Purpose: To determine any difference between bare metal stents (BMS) and balloon-expandable covered stents in the treatment of innominate artery atheromatous lesions. Materials and Methods: A multicenter retrospective study involving 13 university hospitals in France collected 93 patients (mean age 63.2±11.1 years; 57 men) treated over a 10-year period. All patients had systolic blood pressure asymmetry >15 mm Hg and were either asymptomatic (39, 42%) or had carotid (20, 22%), vertebrobasilar (24, 26%), and/or brachial (20, 22%) symptoms. Innominate artery stenosis ranged from 50% to 70% in 4 (4%) symptomatic cases and between 70% and 90% in 52 (56%) cases; 28 (30%) lesions were preocclusive and 8 (9%) were occluded. One (1%) severely symptomatic patient had a <50% stenosis. Demographic characteristics, operative indications, and procedure details were compared between the covered (36, 39%) and BMS (57, 61%) groups. Multivariate analysis was performed to determine relative risks of restenosis and reinterventions [reported with 95% confidence intervals (CI)]. Results: The endovascular procedures were performed mainly via retrograde carotid access (75, 81%). Perioperative strokes occurred in 4 (4.3%) patients. During the mean 34.5±31.2–month follow-up, 30 (32%) restenoses were detected and 13 (20%) reinterventions were performed. Relative risks were 6.9 (95% CI 2.2 to 22.2, p=0.001) for restenosis and 14.6 (95% CI 1.8 to 120.8, p=0.004) for reinterventions between BMS and covered stents. The severity of the treated lesions had no influence on the results. Conclusion: Patients treated with BMS for innominate artery stenosis have more frequent restenoses and reinterventions than patients treated with covered stents.

Download Full-text

Role of stents in hemodialysis vascular access

The Journal of Vascular Access ◽

10.1177/1129729818761280 ◽

2018 ◽

Vol 19 (4) ◽

pp. 341-345 ◽

Cited By ~ 7

Author(s):

Kenneth Abreo ◽

Adrian Sequeira

Keyword(s):

Bare Metal Stents ◽

Arterial Disease ◽

Current Evidence ◽

Metal Stents ◽

Bare Metal ◽

Stent Deployment ◽

Hemodialysis Vascular Access ◽

Nitinol Stents ◽

Arteriovenous Access ◽

Peripheral Arterial

Stents are ubiquitously utilized in coronary and peripheral arterial disease. Interventional nephrologists, however, place stents in the venous outflow of the arteriovenous access. Stenosis is the predominant pathology that causes access dysfunction and will ultimately lead to thrombosis if uncorrected. Angioplasty and stent deployment are the current techniques available to combat stenosis. From initial bare metal stainless steel stents, the current generations of stents used are predominately covered nitinol stents. The latest randomized control trials reveal that stents decrease the number of interventions required to maintain patency but do not improve the overall access survival. Furthermore, bare metal stents have been shown to be inferior to stent grafts. This review discusses indications for stent deployment in the hemodialysis access, the current evidence for their use, and briefly touches on their complications.

Download Full-text