Primary Stenting May Not Be Best for Obstructive Popliteal Lesions

May 30, 2013

By Will Boggs, MD

NEW YORK (Reuters Health) May 30 - Provisional stenting seems better than primary stenting for obstructive lesions of the popliteal artery, according to researchers from Germany.

Endovascular therapy is an established treatment for femoro-popliteal obstructive disease, but the popliteal artery itself has been considered a "no-stent" zone because of the excessive mechanical forces applied to the popliteal artery during motion.

"In comparison to nearly all other vascular beds (e.g., coronary-, iliac-, femoral arteries), stent placement in the popliteal artery does not result in superior patency nor superior clinical outcome," Dr. Aljoscha Rastan from Universitaets-Herzzentrum Freiburg-Bad Krozingen told Reuters Health by email.

Dr. Rastan and colleagues compared nitinol stent placement in the popliteal artery to percutaneous balloon angioplasty alone in 246 patients with obstructive lesions.

A quarter of the patients assigned to angioplasty crossed over to stenting because of flow-limiting dissections and residual stenosis of the target lesion, the researchers reported May 21 online in Circulation.

In the intention-to-treat analysis, six-month and one-year primary patency rates were significantly higher in the stenting group (76.3% and 67.4%, respectively) than in the angioplasty group (45.5% and 44.9%; p=0.0001 and P=0.002).

But when the groups were analyzed by treatment received, there was no significant difference in one-year primary patency rates between stenting and angioplasty (69% vs 63%; p=0.46). Secondary one-year patency rates were also similar for the two groups.

"In the treatment of popliteal artery lesions, primary stenting achieves superior acute technical success and higher primary patency compared to angioplasty, only if provisional stenting is considered as target lesion revascularization (TLR)," the researchers said. "However, provisional stenting, as part of (an angioplasty) strategy, has equivalent one-year patency. Thus, a provisional stenting strategy should be considered over primary stenting for the treatment of popliteal artery lesions."

Three lower leg minor amputations of the target limb were required in each treatment group, but the limb salvage rate was 100% in both groups.

"Two options which have to be evaluated next are drug-eluting balloons and atherectomy for the treatment of popliteal artery lesions," Dr. Rastan said.

In the meantime, Dr. Rastan added, "we are looking forward to the long-term results of the present trial."


Circulation 2013.


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