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Randomized clinical Trial Comparing drug Eluting Stent Zilver PTX® Versus Bare Metal Stent Zilver Flex® for Treatment of Lesions in Femoral and Popliteal Arteries in Chronic Limb Threatening Ischemia

Fransson, Torbjörn LU orcid ; Gottsäter, Anders LU ; Abdulrasak, Mohammad LU ; Malina, Martin LU and Resch, Timothy LU (2023) In Vascular and Endovascular Surgery 57(7). p.706-716
Abstract

Objective: Drug eluting stents (DES) might improve the results of stenting in the femoropopliteal (FP) segment, but randomized data between DES and BMS in the treatment of patients with chronic limb threatening ischemia (CLTI) is lacking. The aim of this study was to perform a randomized comparison, between DES and bare metal stent (BMS) implantation in a subgroup of CLTI patients with lesions in the superficial femoral artery (SFA) and the P1-P2 portion of the popliteal artery. Methods: Patients presenting with CLTI scheduled for endovascular treatment of FP lesions were randomly assigned by blinded envelopes 1:1 in a single blinded, parallel group design to DES or BMS after lesion crossing. Primary endpoints were target lesion... (More)

Objective: Drug eluting stents (DES) might improve the results of stenting in the femoropopliteal (FP) segment, but randomized data between DES and BMS in the treatment of patients with chronic limb threatening ischemia (CLTI) is lacking. The aim of this study was to perform a randomized comparison, between DES and bare metal stent (BMS) implantation in a subgroup of CLTI patients with lesions in the superficial femoral artery (SFA) and the P1-P2 portion of the popliteal artery. Methods: Patients presenting with CLTI scheduled for endovascular treatment of FP lesions were randomly assigned by blinded envelopes 1:1 in a single blinded, parallel group design to DES or BMS after lesion crossing. Primary endpoints were target lesion revascularization (TLR) at 12 and 24 months and primary patency at 12 and 24 months. Secondary endpoints were technical success (TS), clinical success, secondary patency at 12 and 24 months, limb salvage, serious adverse events (SAE) at 24 month and survival at five years. Results: A total of 48 CLTI patients and 49 limbs, were enrolled, 22 in the BMS group and 27 in the DES group. Demographics, comorbidities, and Rutherford class were similar in both treatment arms. The overall rate of total occlusions was 96% and the corresponding overall median lesion length was 240 mm. No patients were lost to follow up. No significant differences were detected between groups regarding TLR and primary patency. The overall primary patency at 12 and 24 months was 42.9% and 36.7% respectively and the overall freedom from TLR was 67.3% and 61.2% respectively. The results in the two groups were also similar regarding secondary outcomes. Conclusions: This single centre, randomized study could not demonstrate superiority of DES compared to BMS when treating long FP lesions in patients with CLTI but was limited by insufficient patient inclusion.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
chronic limb threatening ischemia, drug eluting stent, femoropopliteal lesion, paclitaxel, superficial femoral artery
in
Vascular and Endovascular Surgery
volume
57
issue
7
pages
706 - 716
publisher
SAGE Publications
external identifiers
  • pmid:37085152
  • scopus:85153478116
ISSN
1538-5744
DOI
10.1177/15385744231171746
language
English
LU publication?
yes
id
26b37d08-2b3d-487b-ba72-ef2fdb83c633
date added to LUP
2023-07-14 13:50:41
date last changed
2024-04-19 23:32:20
@article{26b37d08-2b3d-487b-ba72-ef2fdb83c633,
  abstract     = {{<p>Objective: Drug eluting stents (DES) might improve the results of stenting in the femoropopliteal (FP) segment, but randomized data between DES and BMS in the treatment of patients with chronic limb threatening ischemia (CLTI) is lacking. The aim of this study was to perform a randomized comparison, between DES and bare metal stent (BMS) implantation in a subgroup of CLTI patients with lesions in the superficial femoral artery (SFA) and the P1-P2 portion of the popliteal artery. Methods: Patients presenting with CLTI scheduled for endovascular treatment of FP lesions were randomly assigned by blinded envelopes 1:1 in a single blinded, parallel group design to DES or BMS after lesion crossing. Primary endpoints were target lesion revascularization (TLR) at 12 and 24 months and primary patency at 12 and 24 months. Secondary endpoints were technical success (TS), clinical success, secondary patency at 12 and 24 months, limb salvage, serious adverse events (SAE) at 24 month and survival at five years. Results: A total of 48 CLTI patients and 49 limbs, were enrolled, 22 in the BMS group and 27 in the DES group. Demographics, comorbidities, and Rutherford class were similar in both treatment arms. The overall rate of total occlusions was 96% and the corresponding overall median lesion length was 240 mm. No patients were lost to follow up. No significant differences were detected between groups regarding TLR and primary patency. The overall primary patency at 12 and 24 months was 42.9% and 36.7% respectively and the overall freedom from TLR was 67.3% and 61.2% respectively. The results in the two groups were also similar regarding secondary outcomes. Conclusions: This single centre, randomized study could not demonstrate superiority of DES compared to BMS when treating long FP lesions in patients with CLTI but was limited by insufficient patient inclusion.</p>}},
  author       = {{Fransson, Torbjörn and Gottsäter, Anders and Abdulrasak, Mohammad and Malina, Martin and Resch, Timothy}},
  issn         = {{1538-5744}},
  keywords     = {{chronic limb threatening ischemia; drug eluting stent; femoropopliteal lesion; paclitaxel; superficial femoral artery}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{706--716}},
  publisher    = {{SAGE Publications}},
  series       = {{Vascular and Endovascular Surgery}},
  title        = {{Randomized clinical Trial Comparing drug Eluting Stent Zilver PTX® Versus Bare Metal Stent Zilver Flex® for Treatment of Lesions in Femoral and Popliteal Arteries in Chronic Limb Threatening Ischemia}},
  url          = {{http://dx.doi.org/10.1177/15385744231171746}},
  doi          = {{10.1177/15385744231171746}},
  volume       = {{57}},
  year         = {{2023}},
}