Guest Post by Frank J. Criado, MD, FACS, FSVM, editor in chief of Vascular Disease Management.
(Editor’s note: this article is the first in a series of guest posts, a new collaboration between Angioplasty.Org and Vascular Disease Management.)
In the introductory remarks of “Meta-Analysis of Outcomes of Endovascular Treatment of Infrapopliteal Occlusive Disease With Drug-Eluting Stents,” lead author George A. Antoniou and his colleagues, from the Manchester Royal Infirmary in the UK, state that:
“Emerging evidence suggests that the combination of stenting and targeted delivery of drugs with antiproliferative properties, aiming to inhibit smooth muscle cell proliferation and intimal hyperplasia, improves the outcomes of endoluminal treatments of distal vessel disease. A small number of series have demonstrated satisfactory performance of drug-eluting stents, as expressed by increased patency and freedom from revascularisation to maintain good clinical results. Controversy exists, however, with regard to the superiority of drug-eluting stents over bare metal stents in terms of the clinical benefit in critical limb ischaemia patients.”
The authors aimed to conduct a comprehensive literature review and analyze the outcomes of patients with infrapopliteal disease treated with drug-eluting stent and bare metal stents.
The article reports on the results of a meta-analysis of the results of 6 studies including 4 randomized trials and 2 observational studies comprising 544 patients – 287 treated with drug-eluting stents (DES) and 257 treated with bare metal stents (BMS).1 The Cypher sirolimus-eluting stent (Cordis) was used in 4 of the studies, one used the Xience everolimus-eluting stent (Abbott) and one used the Yukon sirolimus-eluting stent (Translumina). Several different types of bare metal stents were implanted.
At 1 year, primary patency was achieved in 80% of the patients treated with DES and 49% of patients treated with BMS (P<.001). The freedom from target lesion revascularization was 89% with DES and 73% with BMS (P<.001). Clinical improvement (of at least one Rutherford category) was reported in three studies. It was achieved in 61% of the patients treated with DES vs 52% of the patients treated with BMS. No significant differences in limb salvage and overall survival at 1 year were identified between the groups.
The authors’ conclusion was that “emerging evidence exists supporting the safety and efficacy of drug-eluting stents in the treatment of infrapopliteal artery disease.” But they also noted that it remains to be seen whether or not improvement in patency rates and target lesion revascularization will be reflected in clinical parameters, such as limb salvage and wound healing.
While much remains to be done and known in this important field, it would be fair to say DES devices will become important tools for lower extremity revascularization – both below and above the knee.
- Antoniou GA, Chalmers N, Kanesalingham K, et al. Meta-analysis of outcomes of endovascular treatment of infrapopliteal occlusive disease with drug-eluting stents. J Endovasc Ther. 2013;20:131-144.
About the author: Frank J. Criado, MD, FACS, FSVM, is an endovascular specialist focusing on aortic, cerebrovascular, and peripheral intervention at MedStar Union Memorial Hospital in Baltimore, MD. He is the editor in chief of Vascular Disease Management, a peer-reviewed publication for the multidisciplinary vascular team.