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Underutilization of Drug-Eluting Stents in Infrapopliteal Intervention for Chronic Limb-Threatening Ischemia

Zachary Zuzek1, Shilpkumar Arora1, Irfan Helmy1

  • 1Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.

Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists
|January 25, 2022
PubMed

Insights

Drug-eluting stents (DES) show better outcomes than bare-metal stents (BMS) for infrapopliteal chronic limb-threatening ischemia (CLTI). Despite evidence, DES are underutilized in real-world CLTI patients, but they are associated with improved limb outcomes.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Health Services Research

Background:

  • Randomized trials indicate drug-eluting stents (DES) outperform bare-metal stents (BMS) for infrapopliteal disease.
  • Real-world data on DES use and outcomes in chronic limb-threatening ischemia (CLTI) patients are limited.

Purpose of the Study:

  • To evaluate drug-eluting stent (DES) utilization and outcomes in patients with infrapopliteal chronic limb-threatening ischemia (CLTI).
  • To compare real-world outcomes of DES versus bare-metal stents (BMS) in this patient population.

Main Methods:

  • Analysis of the Nationwide Readmission Database (NRD) from 2016-2017.
  • Inclusion of patients undergoing infrapopliteal intervention for CLTI using ICD-10 codes.
  • Multilevel logistic regression and Cox-proportional hazard regression were used to assess DES utilization and outcomes, adjusting for confounders.

Main Results:

  • 1817 patients were included; 58.1% received DES.
  • DES utilization was stable between 2016-2017 and higher in teaching and larger hospitals.
  • DES use was associated with a significantly lower rate of major amputation or revascularization compared to BMS (aHR=0.75).

Conclusions:

  • Drug-eluting stents (DES) are underutilized in real-world infrapopliteal interventions for CLTI, despite evidence of superiority.
  • DES use is associated with improved limb salvage outcomes compared to bare-metal stents (BMS) in CLTI patients.
Abstract

Keywords:
angioplastychronic limb-threatening ischemiadrug-eluting stentnationwide readmissions database

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