Covered Stents for Endovascular Treatment of Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 153857442110103
Author(s):  
Austin Mallory ◽  
Stefanos Giannopoulos ◽  
Paul Lee ◽  
Damianos G. Kokkinidis ◽  
Ehrin J. Armstrong
Keyword(s):  
Meta Analysis ◽  
Bare Metal Stents ◽  
Covered Stent ◽  
Primary Patency ◽  
Metal Stents ◽  
Covered Stents ◽  
Stent Group ◽  
Aortoiliac Occlusive Disease ◽  
The Individual

Purpose: The treatment of aortoiliac occlusive disease (AIOD) has largely shifted to endovascular techniques, with primary stenting constituting the preferred treatment approach. The goal of the current study was to summarize available literature and to determine whether covered stents are superior to bare metal stents for the treatment of AIOD, in terms of both periprocedural and long-term outcomes. Methods: A meta-analysis of 47 studies was conducted with the use of random effects modeling. The incidence of adverse events during follow up among the individual included studies was synthesized. Results: Most of the lesions were located at the common iliac arteries and were chronic total occlusions. The procedure was technically successful in almost all cases in both groups, with a low rate of periprocedural complications observed in both groups. The reported primary patency rates for the non-covered and covered stent group during an average follow up of 24.3 months among the individual studies, were 84% and 92% respectively, while surgical or endovascular re-intervention was required in 10% of non-covered stent cases and in 6% of covered stent cases. Eight studies comparing covered vs non-covered stents in terms of patency demonstrated superiority of covered stents (OR: 2.47; 95% CI: 1.01-6.01; p = 0.047 Combining TASC C/D lesions together 12 studies reported 92% (95%CI:89%-95%) primary patency in the covered stent group, while 7 studies reported 75% (95%CI: 60%-88%) primary patency for cases treated with non-covered stents. Conclusion: This study demonstrated that covered stents are safe and effective when utilized for the treatment of AIOD. Covered stents were associated with a statistically significant higher odds of primary patency in both the overall cohort and in more complex TASC C/D lesions. However, additional high-quality comparative analyses between covered vs bare metal stents and between several types of covered stents are needed to determine the most optimal treatment modality for AIOD.

Transbrachial and transfemoral approaches combined with visceral protection for the treatment of juxtarenal aortoiliac occlusive disease: Technical issues and clinical outcomes

Vascular ◽  
2021 ◽  
pp. 170853812110232
Author(s):  
Peixian Gao ◽  
Changliang Li ◽  
Xuejun Wu ◽  
Gang Li ◽  
Dianning Dong ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Bare Metal Stents ◽  
Covered Stent ◽  
Occlusive Disease ◽  
Metal Stents ◽  
Infrarenal Aorta ◽  
Bare Metal ◽  
Stent Grafts ◽  
Aortoiliac Occlusive Disease

Purpose To evaluate the safety and efficacy of transbrachial and transfemoral approaches combined with visceral protection for the endovascular treatment of juxtarenal aortoiliac occlusive disease (AIOD) over an average 19-month follow-up period. Methods In this retrospective analysis, all patients with juxtarenal AIOD at a single institution were reviewed from June 2015 to January 2020. Patient characteristics, angiographic results, and follow-up outcomes were retrospectively recorded. The indications for treatment were critical limb threatening ischemia in 12 patients and bilateral claudication in five patients. Percutaneous access via the left brachial artery was first obtained to recanalize the infrarenal occluded lesions. After that, femoral accesses were achieved. A 4-Fr catheter, a 4 mm balloon, or a 6-Fr 90-cm-long sheath was used to complete visceral artery protection. Results A total of 17 juxtarenal AIOD patients (14 males; mean age, 63.4 ± 8.1 years) underwent endovascular treatment. The technical success rate was 100%. Complete reconstruction was achieved in 15 (88.2%) patients. The infrarenal aorta was reconstructed with kissing covered stent grafts ( n = 7), kissing bare-metal stents ( n = 2), covered stent grafts ( n = 2), bare-metal stents ( n = 1), or the off-label use of iliac limb stent grafts ( n = 5). Renal embolization was found in 3 (17.6%) patients during intraoperative angiography. There was 1 (5.9%) case of distal runoff embolization after CDT and 1 (5.9%) case of left iliac artery rupture. One (5.9%) death occurred due to acute myocardial infarction 20 days after the operation. The average follow-up period was 19.3 ± 16.7 months (range, 1–54 months) in the remaining 16 cases. The renal artery patency rate was 100%. The estimated cumulative primary patency rates were 92.3% at 12 months and 59.3% at 36 months according to the Kaplan–Meier method. Conclusions Transbrachial and transfemoral approaches combined with visceral protection offer a safe and effective alternative to open revascularization for the endovascular treatment of juxtarenal AIOD.

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

2011 ◽  
Vol 4 (3) ◽  
pp. 300-309 ◽  
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

scholarly journals Immunosuppressive Therapy for Restenosis Prevention after Coronary Bare-Metal Stent Implantation -A Meta-Analysis

2019 ◽  
Author(s):  
Yun-Lang Dai ◽  
Jing Zhou ◽  
Yu-Feng Jiang ◽  
Sheng-Da Hu ◽  
Yong-Ming He
Keyword(s):  
Immunosuppressive Therapy ◽  
Meta Analysis ◽  
Bare Metal Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Angiographic Restenosis ◽  
Stent Restenosis ◽  
Risk Patients ◽  
In Stent Restenosis

Abstract Background: Previous studies revealed controversial results regarding the prevention of in-stent restenosis after coronary bare-metal stents (BMS) placement with systemic administration of immunosuppressive drugs. We therefore conducted a meta-analysis to investigate the role played by immunosuppressive therapy (IST) in reducing both in-stent restenosis and adverse clinical events after BMS implantation. Methods: We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases for randomized, controlled studies that investigated the therapeutic effects of IST after BMS insertions. Endpoints assessed were: (1) angiographic restenosis by the end of at least 6 months of follow-up; (2) target vessel revascularization (TVR); and (3) risk of major adverse cardiovascular events (MACE). MACE was defined as death, myocardial infarction and TVR. Results: Nine randomized, controlled trials including 1576 patients (mean age 62 years; follow-up of 6-12 months) were included in this analysis. Meta-analysis showed periprocedural IST + BMS significantly reduced in-stent restenosis as compared to BMS alone (RR: 0.59 [0.39-0.90], P = 0.01). In particular, IST reduced restenosis in high-risk patients (defined as patients with mean reference diameter < 3.0 mm or high periprocedural C-reactive protein level) (RR: 0.34 [0.15,0.74], P = 0.006) rather than in low-risk patients ( P for interaction = 0.06). Similarly, IST also reduced the risk of MACE (RR: 0.63 [0.50-0.80], P < 0.01) and TVR (RR: 0.57 [0.33-0.97], P = 0.04). Conclusions: Periprocedural IST reduces the risk of angiographic restenosis, TVR and MACE in patients with BMS implantation. The advantage of IST is driven mainly by a lower risk of in-stent restenosis in high-risk patients. Key words: immunosuppressive therapy, restenosis, bare-metal stents , meta-analysis

Mechanical Evaluation of Polyvinyl Alcohol Cryogels for Covered Stents

2010 ◽  
Vol 4 (3) ◽  
Author(s):  
Jason D. Weaver ◽  
David N. Ku
Keyword(s):  
Polyvinyl Alcohol ◽  
Membrane Damage ◽  
Balloon Catheter ◽  
Bare Metal Stents ◽  
Covered Stent ◽  
Cellular Migration ◽  
Metal Stents ◽  
Membrane Thickness ◽  
Covered Stents ◽  
Increased Risk

Covered stents could reduce restenosis rates by preventing cellular migration with a physical barrier and may have reduced thrombotic complications if an appropriate material is selected. Previous Dacron™ or poly(tetrafluoroethylene) (PTFE) covered stents have had mixed clinical results in part because they are too thick and too thrombogenic at small diameters. Ideally, the covering should be as thin as a stent strut, mechanically able to expand as much as a stent, and durable enough to withstand deployment. As an alternative to PTFE, thin polyvinyl alcohol (PVA) cryogel membranes were tested for their ability to stretch with uniaxial tension tests and for puncture strength with a modified ASTM method. Additionally, PVA cryogel covered stents were made by coating expanded bare metal stents. These covered stents were then hand-crimped onto a balloon catheter and expanded. PVA cryogel membranes were made as thin as 100 μm—thinner than some stent struts—and stretched to approximately 3.0 times their original diameter (similar to a stent during deployment). PVA cryogel membranes resisted puncture well with an average push-through displacement of 4.77 mm—allowing for safe deployment in vessels of up to 9 mm in diameter. Push-through displacement did not depend on membrane thickness in the range tested—a trait that could reduce stent profile without increased risk of puncture. All the PVA cryogel covered stents tolerated the crimping and expansion process well and there was little to no visible membrane damage. In conclusion, based on the results of these mechanical tests, PVA cryogels are mechanically suitable for covered stent membranes. This work represents a first step toward the creation of a new class of covered stent, which could prevent complications from both restenosis and thrombosis.

scholarly journals Comparative performance analysis of interventional devices for the treatment of ischemic disease in below-the-knee lesions: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Emi Kearon Matsuoka ◽  
Terumitsu Hasebe ◽  
Ryota Ishii ◽  
Naoki Miyazaki ◽  
Kenzo Soejima ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Bare Metal Stents ◽  
Primary Patency ◽  
Metal Stents ◽  
Lesion Length ◽  
Analysis Model ◽  
Comparative Performance ◽  
Ischemic Disease ◽  
Below The Knee ◽  
Significant Difference

AbstractThis meta-analysis aimed to evaluate the device performance of conventional balloon catheters (POBA), drug-coated balloons (DCB), bare-metal stents (BMS), and drug-eluting stents (DES) in below-the-knee (BTK) ischemic lesions with regard to lesion characteristics. Online searches of PubMed, Web of Science, and Cochrane databases (2010–2019) were conducted for each of the test devices. Primary patency rates (pp) and major amputation rates 1 year after the use of each device were analyzed using a random-effects meta-analysis model. Meta-regression analysis was conducted to test associations between the outcomes and lesion characteristics. The analysis included 18 studies reporting on 24 separate cohorts comprising 2,438 patients. DES demonstrated the best pp among the test devices (83.6%; 95% confidence interval = 78.4–88.8%, studies = 8; I2 = 66%, P = 0.005). A negative coefficient between lesion length and pp (P = 0.002) was obtained. The ratio of critical limb ischemia (CLI) patients impacted the amputation rates (P = 0.031), whereas no statistically significant difference was found between the devices. DES showed favorable pp in BTK lesions; however, as the lesion lengths using DES were short, pp in long lesions still needs to be evaluated. Shorter lesions gained better pp. A higher ratio of CLI patients resulted in increased amputation rates.

Meta-Analysis Comparing the Effect of Drug-Eluting Versus Bare Metal Stents on Risk of Acute Myocardial Infarction During Follow-Up

2007 ◽  
Vol 99 (5) ◽  
pp. 621-625 ◽  
Author(s):  
Raúl Moreno ◽  
Cristina Fernández ◽  
Luis Calvo ◽  
Angel Sánchez-Recalde ◽  
Guillermo Galeote ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Meta Analysis ◽  
Bare Metal Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Drug Eluting

Comprehensive Meta-Analysis on Drug-Eluting Stents versus Bare-Metal Stents during Extended Follow-up

2009 ◽  
Vol 122 (6) ◽  
pp. 581.e1-581.e10 ◽  
Author(s):  
Henri Roukoz ◽  
Anthony A. Bavry ◽  
Michael L. Sarkees ◽  
Girish R. Mood ◽  
Dharam J. Kumbhani ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Bare Metal Stents ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Drug Eluting
Sign in / Sign up

Export Citation Format

Share Document