Abstract 1788: Clinical Impact of the Diameter of a Self-expandable Stent in the Superficial Femoral Artery

Background Factors associated with patency of self-expandable stents placed in the superficial femoral artery (SFA) have not been clarified. In this study, we investigated the impact of stent diameter in patients who implanted self-expandable stents in the SFA. Methods Self-expandable stents were placed in SFA lesions in 80 patients (84 limbs) at our hospital between January 2003 and December 2005 and we investigated prospectively for 18 months. A total of 144 stents were used: The mean vascular diameter at sites proximal and distal to the stent-placement region on angiography was defined as the vessel diameter, and the stent diameter/vessel diameter (S/V) ratio was calculated. Results The age of the patients ranged from 44 to 88 years old (mean: 70.3 ± 6.8 years old), and 68 patients were male (85%). The mean diameter of the treated vessels was 5.1 ± 0.7 mm, the mean lesion length was 93.8 ± 43.8 mm, and 1.7 ± 0.6 stents were used per lesion. Chronic total occlusion was noted in 24 cases (30%). The primary (secondary) patency rates at 6, 12, and 18 months were 91.2% (97.5%), 74.5% (87.2%), and 63.6% (79.1%), respectively as estimated by the Kaplan-Meier method. An S/V ratio >1.3 was noted in 16 of the 80 patients (20%). There was a high percentage of patients with renal dysfunction and a smoking habit in this group, and the length of the treated lesion was long. In contrast, there were fewer patients with a high cholesterol level in this group. Other baseline parameters were similar between the two groups. A Kaplan-Meier estimate showed that the restenosis rate after 18 months was significantly higher in the S/V >1.3 group (87.5% vs. 35.5%, p<0.0001), whereas the primary patency was lower (31.3% vs. 73.4%, p<0.0001). Multivariate analysis indicated that lesion length >100 mm (Hazard ratio (HR) 6.6, p=0.015), chronic total occlusion (HR 6.0, p=0.035), stent fracture(HR 17.5, p=0.022), and S/V >1.3(HR 29.0, p=0.0014) were independent predictors of primary patency at 18 months. conclusion The stent diameter of self-expandable stent was strongest predictor in primary patency at 18 months. The stent diameter of self-expandable stent can affect patency in the chronic phase.

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Lumen Loss at 1 Year After Bare Nitinol Stent Implantation in the Superficial Femoral Artery

Journal of Endovascular Therapy ◽

10.1177/1526602820950261 ◽

2020 ◽

pp. 152660282095026

Author(s):

Nobuhiro Ito ◽

Mitsuyoshi Takahara ◽

Yoshimitsu Soga ◽

Seiichi Hiramori ◽

Kaoru Hirose ◽

...

Keyword(s):

Femoral Artery ◽

Superficial Femoral Artery ◽

Failure Time ◽

De Novo ◽

Vessel Diameter ◽

Accelerated Failure Time Model ◽

Lesion Length ◽

Time Model ◽

Nitinol Stent ◽

The Mean

Purpose To investigate lumen loss (LL) at 1 year after bare nitinol stent (BNS) implantation for de novo superficial femoral artery (SFA) lesions. Materials and Methods The subjects were 701 consecutive patients (mean age 74±9 years; 492 men) with 817 de novo SFA lesions treated with BNS implantation between January 2004 and September 2015. The mean lesion length was 141±88 mm and the mean vessel diameter was 5.4±0.9 mm. The endpoint was LL at 1 year after BNS implantation. Secondary outcomes were restenosis and target lesion revascularization (TLR) estimated using the Kaplan-Meier method; estimates are reported with the 95% confidence interval (CI). LL was defined as the minimum lumen diameter immediately after BNS implantation minus that at 1 year measured by angiographic quantitative vessel analysis. The distribution of LL in the overall population was estimated using an accelerated failure time model. Results Mean LL at 1 year was estimated to be 1.74±1.28 mm (95% CI 1.63 to 1.84). Current smoking was positively associated with LL (p=0.015), whereas lack of cilostazol use was correlated with an increase in LL (p=0.001). Reference vessel diameter and lesion length did not have any significant association with LL at 1 year. The 1-year cumulative estimate of restenosis was 25% (95% CI 22% to 28%); the corresponding value for TLR was 18% (95% CI 15% to 21%). Conclusion Mean LL progressed by at least 1.6 mm at 1 year after BNS implantation. The risk factors for increased LL were current smoker and lack of cilostazol use.

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Abstract 13533: 1-Year Results of Paclitaxel-Coating Nitinol Stent Placement for Chronic Total Occlusion in the Femoropopliteal Artey

Circulation ◽

10.1161/circ.130.suppl_2.13533 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Naotaka Murata ◽

Yoshimitu Soga ◽

Yusuke Tomoi ◽

Seiichi Hiramori ◽

Yohei Kobayashi ◽

...

Keyword(s):

Chronic Total Occlusion ◽

Ankle Brachial Index ◽

Primary Patency ◽

Lesion Length ◽

Total Occlusion ◽

Femoropopliteal Artery ◽

Nitinol Stent ◽

Kaplan Meier ◽

Zilver Ptx

Introduction: The mid-term outcomes of paclitaxel-coating nitinol stent (Zilver PTx) placement for chronic total occlusion (CTO) in the femoropopliteal artery have not been assessed. Hypothesis: Zilver PTx placement for CTO in the femoropopliteal artey is reliable. Methods: All patients enrolled in this prospective, single center study underwent Zilver PTx placement for de novo or restenotic CTO and non-CTO in the superficial femoral and/or popliteal artery. Baseline and follow-up Rutherford classification and Ankle-brachial index (ABI) measurements were obtained. Follow-up was completed at 3, 6, 12 months. Results: There were 61 of CTO and 58 of non-CTO treated. Mean age was 74 ± 8 years and male was 82 % in overall. Patients characteristics and degree of lesion calcification was not different significantly between two groups. CTO group had a longer mean lesion length than non-CTO group (209 mm ± 93 mm vs 131 mm ± 87 mm, P < .0001). Procedural success in both treatments was over 98 %. The operative complications were 3 cases in CTO group and 2 cases in non-CTO group. The primary patency of CTO group was significantly lower than non-CTO group in Kaplan-Meier estimate curves at 12 months (75 % vs 82 %, Log-rank P < 0.05). There were no significant differences in event-free survival or freedom from target lesion revascularization in Kaplan-Meier estimate curves at 12 months (68 % vs 70 %; Log-rank P = 0.82, 63 % vs 65 %; Log-rank P = 0.47, respectively). Both groups experienced a significant improvement in Rutherford classification and ABI after treatment, and these improvements were sustained to 12-months follow-up. Based on multivariate analysis, CTO was the negative predictor for primary patency at 12 months (HR 2.37, 95 % CI 1.02 to 5.9, adjusted P < 0.05). Conclusions: CTO influences negatively the primary patency of Zilver PTx placed in the femoropopliteal artery. However, Improvement of Rutherford classification and ABI at 12-months after CTO- intervention is sustained.

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Impact of chronic outward force on arterial responses of proximal and distal of long superficial femoral artery stent

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02141-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hu Li ◽

Seung-Woon Rha ◽

Byoung Geol Choi ◽

Se Yeon Choi ◽

Sang Ki Moon ◽

...

Keyword(s):

Femoral Artery ◽

Superficial Femoral Artery ◽

Distal Segment ◽

Vessel Diameter ◽

Distal Portion ◽

Control Group ◽

Stent Restenosis ◽

Histopathologic Analysis ◽

Stent Diameter ◽

The Impact

Abstract Background Self-expanding nitinol stent (SENS) implantation is commonly oversized in the superficial femoral artery (SFA), and leads to chronic outward force (COF) and in-stent restenosis (ISR). This study aimed to investigate the impact of COF of oversizing SENS on ISR of SFA. Methods In patients with implanted SENS in SFA, intimal hyperplasia especially between proximal segment and distal segment was evaluated by quantitative angiography, and the impact of COF on mid-term angiographic outcomes was investigated. In addition, porcine model with implanted SENS was used to evaluate the impact of COF on angiographic and histopathologic outcomes at 1 month. Excised stented arteries were evaluated by histopathologic analysis. Results We analyzed 65 SENS in 61 patients with follow-up angiography at 6 months to 1 year. The baseline diameter was 6.8 ± 0.71 mm and length were 97.0 ± 33.8 mm for the SENS. The ratio of the diameter of the stent to the reference vessel was 1.3 ± 0.24 at the proximal portion and 1.53 ± 0.27 at the distal portion (P < 0.001). In the long SFA stent, stent-to-vessel ratio was significantly higher in the distal stent than in the proximal stent (1.3 ± 0.2 vs. 1.55 ± 0.25, P = 0.001). ISR incidence was higher at the distal stent (37.3% vs 52.6%, P = 0.029). All 11 pigs survived for 4 weeks after SENS implantation. The vessel diameter was 4.04 ± 0.40 mm (control group) vs 4.45 ± 0.63 mm (oversized group), and the implanted stent diameter was 5.27 ± 0.46 mm vs. 7.18 ± 0.4 mm (P = 0.001). The stent-to-vessel diameter ratio was 1.31 ± 0.12 versus 1.63 ± 0.20 (P < 0.001). After 4 weeks, restenosis % was 29.5 ± 12.9% versus 46.8 ± 21.5% (P = 0.016). The neointimal area was 5.37 ± 1.15 mm2 vs. 8.53 ± 5.18 mm2 (P = 0.05). The restenosis % was 39.34 ± 8.53% versus 63.97 ± 17.1% (P = 0.001). Conclusions COF is an important cause of restenosis in the distal portion of the SFA stent. Optimal sizing of the SFA stent is important to reduce the incidence of restenosis. Therefore, COF was an important factor of restenosis following distal SFA stenting.

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