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Does stent overlap influence the patency rate of aortoiliac kissing stents?
Andreas Greiner1, Hannes Mühlthaler, Beate Neuhauser
1Department of Vascular Surgery, Medical University Innsbruck, Austria. andreas.greiner@uibk.ac.at
Insights
Kissing stent overlap in the distal aorta significantly impacts patency rates. Greater overlap in kissing stents correlates with lower primary and assisted primary patency for aortoiliac occlusive disease.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Imaging
Background:
- Atherosclerotic aortoiliac occlusive disease is a common condition requiring revascularization.
- Kissing stents are frequently used to treat aortoiliac occlusive disease, particularly at the aortic bifurcation.
- The optimal positioning of kissing stents to maximize long-term patency remains an area of investigation.
Purpose of the Study:
- To investigate the relationship between the positioning of kissing stents in the distal aorta and their subsequent patency rates.
- To determine if the degree of proximal stent overlap influences the success of endovascular treatment for aortoiliac occlusive disease.
Main Methods:
- Retrospective review of 41 patients treated with angioplasty and kissing stents for atherosclerotic aortoiliac occlusive disease.
- Patients were categorized into "crossing" (overlap > half width) and "non-crossing" (overlap ≤ half width) groups based on post-interventional radiographs.
- Life-table analysis was used to assess primary and assisted primary patency rates at 2 years.
Main Results:
- Overall 2-year primary and assisted primary patency rates were 60.8% and 69.4%, respectively.
- The "non-crossing" group demonstrated significantly higher 2-year primary (94.1%) and assisted primary (100%) patency rates compared to the "crossing" group (33.2% and 45.3%, respectively; p=0.01).
- No significant differences in baseline demographics, morphology, or procedural variables were observed between the groups.
Conclusions:
- The degree of proximal kissing stent overlap in the distal aorta is a critical factor influencing stent patency.
- Increased overlap of kissing stent ends in the aortic bifurcation is associated with a significantly higher risk of stent failure.
- Optimizing stent placement to minimize proximal overlap may improve long-term outcomes for patients undergoing kissing stent procedures.
Purpose:
To determine if the position of kissing stents in the distal aorta has any influence on the patency rate.
Methods:
A retrospective review was conducted of 41 patients (22 men; median age 60.8 years, range 44-86) electively treated for atherosclerotic aortoiliac occlusive disease with angioplasty and kissing stents between January 1997 and January 2005. Two patient groups were defined by reviewing postinterventional anteroposterior radiograms: (1) patients in whom the proximal end of the kissing stents overlapped more than half of their angiographic width within the aorta ("crossing" group) and (2) patients in whom the proximal ends of the stents overlapped half of their width or less ("non-crossing" group).
Results:
At 2 years, the primary and assisted primary patency rates by life-table analysis were 60.8% and 69.4%, respectively, for the 35 patients included in the life-table analysis. There was no significant difference between the 16-patient "crossing" group and the 19-patient "non-crossing" group in terms of the baseline demographic, morphological, and procedural variables. The primary and assisted primary patency rates at 2 years for the "non-crossing" group were significantly higher (94.1% and 100%, respectively) compared to 33.2% and 45.3%, respectively, for the "crossing" group (p=0.01).
Conclusions:
Failure of kissing stents in the aortic bifurcation may be significantly increased by the overlap of the free proximal stent ends in the distal aorta.
