Iwata Yo, Ueshima Daisuke, Jujo Kentaro, Kaneko Nobuhito, Umemoto Tomoyuki, Utsunomiya Makoto, Doijiri Tatsuki, Murata Teppei, Miyazaki Toru, Yamaguchi Tetsuo, Kobayashi Yoshio
Department of Cardiology, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan.
Department of Cardiology, University of Padova, Padua, Italy.
Cardiovasc Interv Ther. 2018 Oct;33(4):372-378. doi: 10.1007/s12928-017-0499-0. Epub 2017 Oct 26.
Crossover stenting of femoral bifurcation raises the concern of jeopardizing the deep femoral artery (DFA) entry, thereby increasing future risk of limb-threatening ischemia and amputation. This retrospective multicenter study compared clinical outcomes of crossover stenting and non-crossover stenting for ostial superficial femoral artery (SFA) lesions. We reviewed 125 limbs in 103 patients with successful stent implantation for ostial SFA lesions and allocated them to two groups, based on whether the stent crossed over the DFA orifice (CO, n = 54) or not (NC, n = 71). The decision of applying whether CO or NC was at the operators' discretion. Primary endpoints were incidences of major amputation and acute limb ischemia (ALI) at 24 months, and secondary endpoints were incidences of death, target lesion revascularization (TLR), composite of amputation or death, and major adverse limb events which was a composite of major amputation, ALI, TLR, or death at 24 months. Baseline characteristics were similar between the groups. Major amputation occurred only in the NC group, while ALI occurred only in the CO group. Kaplan-Meier estimation showed no significant differences in incidences of major amputation (NC: 3.0% vs. CO: 0.0%, p = 0.21), ALI, or any of the secondary endpoints. However, there was a trend towards higher incidence of ALI in the CO group (NC 0.0% vs. CO 3.9%, p = 0.11). Crossover stenting did not result in a significant difference in major amputation compared to non-crossover stenting within 24 months. However, it showed a trend towards higher incidence of ALI.
股动脉分叉处的交叉支架置入术引发了对危及股深动脉（DFA）入口的担忧，从而增加了未来肢体威胁性缺血和截肢的风险。这项回顾性多中心研究比较了交叉支架置入术和非交叉支架置入术治疗股浅动脉（SFA）开口处病变的临床结果。我们回顾了103例成功植入SFA开口处病变支架的患者的125条肢体，并根据支架是否跨过DFA开口（CO组，n = 54）或未跨过（NC组，n = 71）将他们分为两组。应用CO或NC的决定由操作者自行决定。主要终点是24个月时大截肢和急性肢体缺血（ALI）的发生率，次要终点是死亡、靶病变血管重建（TLR）、截肢或死亡的复合终点以及24个月时大截肢、ALI、TLR或死亡的复合终点即主要不良肢体事件的发生率。两组间基线特征相似。大截肢仅发生在NC组，而ALI仅发生在CO组。Kaplan-Meier估计显示，大截肢（NC：3.0% vs. CO：0.0%，p = 0.21）、ALI或任何次要终点的发生率无显著差异。然而，CO组ALI发生率有升高趋势（NC 0.0% vs. CO 3.9%，p = 0.11）。与24个月内的非交叉支架置入术相比，交叉支架置入术在大截肢方面没有显著差异。然而，它显示出ALI发生率有升高趋势。
