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Infrapopliteal stenting with silicon carbide-coated stents in critical limb ischemia: a 12 month follow-up study
Eli Atar1, Ram Avrahami, Yuri Koganovich
1Department of Diagnostic Radiology and Unit of Vascular and Interventional Radiology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel. Atareli@hotmail.com
Insights
Silicon carbide-coated stents show comparable outcomes to bare metal stents for critical limb ischemia (CLI) in elderly patients. These stents offer a viable option for infrapopliteal interventions when stenting is necessary.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Biomaterials Engineering
Background:
- Critical limb ischemia (CLI) presents a growing challenge with significant surgical risks and limited non-surgical treatments.
- Infrapopliteal artery stenoses are a common cause of CLI, particularly in elderly patients.
Purpose of the Study:
- To assess the efficacy of silicon carbide-coated Motion stents in elderly patients with infrapopliteal artery stenoses causing CLI.
- To compare the outcomes of these coated stents against reported data for bare metal stents following failed or complicated percutaneous transluminal angioplasty (PTA).
Main Methods:
- A prospective study involving 17 elderly patients (mean age 82) with CLI who received 41 silicon carbide-coated Motion stents after unsuccessful PTA.
- Patients had significant comorbidities and were at high surgical risk, with varying degrees of lower limb artery run-off.
- Pre- and post-intervention assessments included clinical evaluation, ankle-brachial index (ABI), and Doppler ultrasound.
Main Results:
- 100% technical success rate for stent placement.
- Primary patency rates at 12 months were 40%, with a secondary patency rate of 60%.
- Significant improvement in mean ABI from 0.32 to 0.53 at one year, with clinical improvement in 66.6% of patients.
Conclusions:
- Silicon carbide-coated stents demonstrate comparable patency and clinical outcomes to bare metal stents in infrapopliteal interventions for CLI at 6 and 12 months.
- These coated stents represent a viable treatment option for CLI patients undergoing infrapopliteal stenting.
- The study highlights the potential of advanced stent coatings in managing complex vascular conditions.
Background:
Critical limb ischemia is an increasingly common condition that has high surgical morbidity and limited non-surgical options.
Objectives:
To evaluate the use of silicon carbide-coated Motion stents, as compared to reported data for bare metal stents, in elderly patients with infrapopliteal artery stenoses causing critical limb ischemia after failed or complicated percutaneous transluminal angioplasty.
Methods:
Between January 2003 and March 2004, 41 stents were inserted into 17 consecutive patients (11 males, 6 females, mean age 82 years, range 75-93) following unsuccessful or complicated PTA. Seven patients had one-vessel run-off, six had two-vessel and four had three vessel run-off. All patients suffered from CLI, had up to three lesions and more than one co-morbid condition, and were considered at high surgical risk. Silicon carbide-coated Motion coronary stents, 2.5-4 mm diameterand 25 and 30 mm length, were used. Pre-intervention assessment included clinical condition, ankle brachial index, Doppler ultrasound and digital subtracted angiography. Postintervention evaluation included clinical condition, ABI and Doppler ultrasound at 3, 6 and 12 months.
Results:
The technical success rate per lesion was 100% (41/41). Two patients died of unrelated causes after 2 and 8 months respectively. Primary patency rates with duplex ultrasound were 68.7% (11/16) at 3 months, 43.7% (7/16) at 6 months and 40% (6/15) after 12 months. Nine patients developed complete occlusion in 13 stents; three of these patients underwent a below-knee amputation and two patients a partial foot amputation. Re-intervention (PTA only) was performed in 7 patients (43.7%). Secondary patency rate was 81.2% (13/16) at 6 months and 60% (9/15) at one year. Mean ABI index had improved at 6 months from 0.32 to 0.67, and to 0.53 at one year. Clinical improvement was evident in 87.5% (14/16) at 6 months and in 66.6% (10/15) at one year.
Conclusions:
Silicon carbide-coated stents are comparable to bare metal stents after 6 and 12 months in infrapopliteal interventions in CLI when stenting is indicated.
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