Division of Vascular/Endovascular Surgery, University of California Davis Medical Center, Sacramento, Calif.
Division of Interventional Cardiology, University of Colorado, Denver, Colo.
J Vasc Surg. 2014 Aug;60(2):337-43. doi: 10.1016/j.jvs.2014.02.055. Epub 2014 Apr 13.
Randomized trials and retrospective data suggest that covered balloon-expandable (CBE) stents have better short-term patency compared with balloon-expandable bare-metal stents (BMSs) in the treatment of iliac artery disease. This study evaluated midterm outcomes of BMSs vs CBE stents placed in the common iliac artery (CIA) for aortoiliac occlusive disease.
All endovascular interventions for symptomatic peripheral arterial occlusive disease performed at a single institution from 2006 to 2012 were reviewed. Patients undergoing stent placement in the CIA segment were included in the analysis. Demographic data, TransAtlantic Inter-Society Consensus (TASC) classification, stent type, patency, and limb reinterventions were compared.
For treatment of de novo distal aorta or CIA stenosis, 254 procedures were performed in 162 patients. BMSs were used in 190 arteries; CBE stents were used in 64 arteries. There was no difference in age, gender, or TASC classification between the two groups. Mean follow-up was 22 ± 16 months. Primary patency, assisted patency, and secondary patency were significantly better in the BMS group. CIAs treated with covered stents were more likely at 1 year or longer to require repeated intervention (hazard ratio, 2.5; 95% confidence interval, 1.2-5.3; P = .009). TASC classification did not predict need for reintervention in either group. Multivariate analysis revealed dual antiplatelet therapy to be the only other factor to affect patency during long-term follow-up.
In this study, BMSs had significantly better patency compared with CBE stents for treatment of aortoiliac occlusive disease. A randomized trial comparing patency as well as restenosis rates with long-term follow-up is needed to determine if there is any benefit from use of covered stents in the aortoiliac segment.
随机试验和回顾性数据表明，与裸金属支架（BMS）相比，覆膜球囊扩张（CBE）支架在治疗髂动脉疾病时具有更好的短期通畅率。本研究评估了 BMS 与 CBE 支架在治疗主髂动脉闭塞性疾病中的中期结果。
回顾性分析了 2006 年至 2012 年在一家机构进行的所有治疗症状性外周动脉闭塞性疾病的血管内介入治疗。分析纳入了在 CIA 节段进行支架置入的患者。比较了人口统计学数据、跨大西洋腔内血管学会共识（TASC）分类、支架类型、通畅率和肢体再介入情况。
对于治疗新发的远端主动脉或 CIA 狭窄，162 例患者共进行了 254 次手术。190 支动脉使用 BMS，64 支动脉使用 CBE 支架。两组患者在年龄、性别或 TASC 分类方面无差异。平均随访时间为 22±16 个月。BMS 组的主要通畅率、辅助通畅率和二级通畅率显著更高。在 1 年或更长时间内，接受覆膜支架治疗的 CIA 更有可能需要再次介入（风险比，2.5；95%置信区间，1.2-5.3；P=0.009）。在两组中，TASC 分类均不能预测需要再次介入。多变量分析显示，长期随访中，双联抗血小板治疗是影响通畅率的唯一其他因素。
在本研究中，BMS 在治疗主髂动脉闭塞性疾病时的通畅率明显优于 CBE 支架。需要进行一项随机试验，比较通畅率和再狭窄率，并进行长期随访，以确定在主髂动脉段使用覆膜支架是否有任何益处。
