Giuseppe Biondi Zoccai

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Presentation transcript:

Giuseppe Biondi Zoccai Drug-eluting or absorbable stents versus bare-metal stents in peripheral artery disease Giuseppe Biondi Zoccai Divisione di Cardiologia, Università di Torino gbiondizoccai@gmail.com

Biondi Zoccai et al, G Ital Cardiol 2009 Scope of the problem Biondi Zoccai et al, G Ital Cardiol 2009

Scope of the problem - II

Scope of the problem - III

TASC II 2007 vs. TASC 2000

Why stents? Balloon-only angioplasty is fraught with: Elastic recoil Flow-limiting dissection Constrictive remodeling Neointimal hyperplasia Biocompatibility Stents may address these issues

Why stents? Balloon-only angioplasty is fraught with: Elastic recoil Flow-limiting dissection Constrictive remodeling Neointimal hyperplasia Biocompatibility Stents may address these issues BMS

Why stents? Balloon-only angioplasty is fraught with: Elastic recoil Flow-limiting dissection Constrictive remodeling Neointimal hyperplasia Biocompatibility Stents may address these issues DES

Why stents? Balloon-only angioplasty is fraught with: Elastic recoil Flow-limiting dissection Constrictive remodeling Neointimal hyperplasia Biocompatibility Stents may address these issues ABS

Explosion of data on stents for PAD PubMed queried on 7 December 2009: stent* AND (femoral OR popliteal OR femoropopliteal OR "femoro-popliteal" OR tibial OR "infra-popliteal" OR infrapopliteal OR (critical AND limb AND ischemia)) NOT (vein OR venous)

Iliac stenting: just in bail-out? Dutch Iliac Stent Trial: randomized trial of stenting vs balloon-only PTA (with stent if complications or mean gradient >10 mm Hg)* *stenting finally performed in 40% of pts randomized to PTA Routine stenting PTA with selective stenting Klein et al, Radiology 2006

The FAST trial: Luminexx stent

The ABSOLUTE trial: Absolute stent Schillinger et al, Circulation 2007

The RESILIENT II trial: LifeStent 12-month results

Can you beat new bare-metal stents?

The SIROCCO I trial: Sirolimus-eluting Smart stent Duda et al, Circulation 2002

Duda et al, J Vasc Interv Radiol 2005 The SIROCCO II trial: Sirolimus-eluting Smart stent Freedom from restenosis 71.8% 67.2% Duda et al, J Vasc Interv Radiol 2005

Zilver paclitaxel eluting stent

Repeat PTA after BTK stenting Biondi-Zoccai et al, J Endovasc Ther 2009

What about absorbable stents? BASELINE POST-AMS 6 MONTHS Bosiers et al, Cardiovasc Intervent Radiol 2009

What about absorbable stents? 6-month angiographic patency rate: 31.8% for AMS vs. 58.0% for PTA (p=0.013) Bosiers et al, Cardiovasc Intervent Radiol 2009

Take home messages Primary stenting with self-expandable bare-metal stents is considered by many the standard of care for iliac and superficial femoral arteries Bail-out drug-eluting stenting is beneficial for infra-popliteal lesions Conversely, stents (any) should be avoided in common femoral or popliteal arteries Further clinical evidence is needed before deciding on the role of absorbable stents and femoral drug-eluting stents

Thank you for your attention For any correspondence: gbiondizoccai@gmail.com For these and further slides on these topics feel free to visit the metcardio.org website: http://www.metcardio.org/slides.html