Direct Stent Placement versus Percutaneous Mechanical Thrombectomy in Selected Patients with Acute Lower Limb...

To compare the safety and effectiveness of direct stent placement (DS) technique versus percutaneous mechanical thrombectomy (PMT) in patients with acute lower limb ischemia (ALI).

This 10-year retrospective study included 50 selected patients of 465 patients who presented with ALI (Society for Vascular Surgery [SVS]/International Society for Cardiovascular Surgery [ISCVS] IIa, n = 24; SVS/ISCVS IIb, n = 26). The underlying causes included in situ thrombosis (n = 41) and embolism (n = 9). Patients were treated either with DS technique (n = 20) involving deployment of self-expanding stents across acute arterial occlusions or with PMT (n = 30) using AngioJet device.

Technical success was achieved in all cases. Access site adverse events (hematoma, dissection, and pseudoaneurysm) occurred in 2 patients in the DS group and 4 patients in the PMT group. No cases of reperfusion injury and 1 case of distal embolization in PMT group were reported. During follow-up, 2 minor and 2 major amputations were performed in the DS group and 3 major and 3 minor amputations in the PMT group. Primary patency rates for the DS and PMT group were 90% and 78.6% at 1 year, 84.7% and 74.2% at 2 years, and 69.3% and 69.6% at 3 years, respectively (P = .789). Amputation-free survival rates for the DS and PMT group were 85% and 86.7% at 1 year, 72.9% and 77.5% at 3 years, and 65% and 77.5% at 4 years, respectively (P = .635).

DS seems to be a safe and effective bailout treatment option for ALI, when PMT is unavailable, demonstrating comparable outcomes with PMT.