November 09, 2017
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In small peripheral vessels, angioplasty alone may confer best results

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Patients with lesions in femoropopliteal vessels with a diameter smaller than 4 mm who were treated with balloon angioplasty alone had improved primary patency compared with those treated with routine or bailout stenting, according to an analysis published in Catheterization and Cardiovascular Interventions.

Norihiko Kamioka, MD, of the department of cardiology at Kokura Memorial Hospital in Kitakyushu, Japan, and colleagues analyzed data from 337 patients (mean age, 72 years; 40% women) from the REAL-FP study who underwent endovascular therapy from 2004 to 2011 for femoropopliteal artery disease that affected the superficial femoral artery. Patients underwent a balloon angioplasty (n = 229) or stenting (n = 108).

Both groups were prescribed 81 mg to 100 mg aspirin per day and either 200 mg per day ticlopidine or 75 mg per day clopidogrel before the procedure. All patients were recommended lifelong aspirin therapy after the procedure. Those who received stents were recommended to take thienopyridines for at least 1 month.

The primary endpoint was cumulative incidence of primary patency after the procedure at 3 years. Secondary endpoints were 3-year incidence of assisted primary patency, freedom from major adverse limb events and secondary patency, defined as total occlusion of a target vessel that was then reopened by repeat revascularization.

At 3 years, 53.8% of patients who underwent balloon angioplasty achieved primary patency vs. 34.2% of those who received a stent (P = .002). The balloon group also had higher instances of freedom from major adverse limb events (60.6% vs. 36.4%; P = .001) and assisted-primary patency (70.9% vs. 44.2%; P < .001) compared with the stent group.

Cumulative incidence of secondary patency at 3 years did not differ between the balloon (86.9%) and stent groups (86.9%; P = .67).

Restenosis was predicted by stent implantation (HR = 1.68, 95% CI, 1.15-2.41), no administration of cilostazol (HR = 1.5; 95% CI, 1.07-2.13), diabetes (HR = 1.61; 95% CI, 1.14-2.31) and lesion length greater than 75 mm (HR = 2.09; 95% CI, 1.5-2.92).

“Mismatch of the stent diameter and the vessel diameter (ie, a ratio greater than 1.3) has been associated with [in-stent restenosis],” Kamioka and colleagues wrote. “As available stent sizes for small vessels are limited, the mismatch and stress against the vascular wall in small vessels may be more pronounced resulting in a higher restenosis rate than in larger vessels. Furthermore, inflammation derived from continuous excessive outward-force against the vessel wall is likely less in [balloon angioplasty] alone than following stent implantation.” – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.