Ko Young-Guk, Ahn Chul-Min, Rha Seung-Woon, Yu Cheol Woong, Park Sang Ho, Lee Seung Jin, Lee Jae-Hwan, Her Sung-Ho, Kang Woong Chol, Cho Young-Seok, Seo Jae-Bin, Cho Yun Hyeong, Choi Donghoon
Division of Cardiology and Cardiovascular Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Korea University Guro Hospital, Seoul, South Korea.
Ann Vasc Surg. 2019 Jul;58:101-107. doi: 10.1016/j.avsg.2018.11.023. Epub 2019 Feb 13.
Optimal stenting strategy for long femoropopliteal artery lesions still remains undefined. Longer stent length has been shown to be associated with increased risk of restenosis. We sought to compare the efficacy of spot versus long stenting in the treatment of femoropopliteal artery disease.
This study was designed as a multicenter randomized controlled trial to compare immediate and mid-term outcomes of spot versus long primary stenting for femoropopliteal arterial lesions. A total of 125 patients were randomized 1:1 to spot stenting group (n = 59) or long stenting group (n = 66).
All lesions were treated with self-expanding bare nitinol stents. Baseline clinical and lesion characteristics were similar between the 2 groups except for male gender and current smoker. The mean lesion length was 24.1 ± 8.8 cm. Technical success was achieved in all patients. The 1-year primary patency and TLR-free (target lesion revascularization) survival did not differ significantly between the 2 groups. However, the spot stenting group showed a trend toward higher primary patency (86.1% vs. 72.7%, P = 0.158) and TLR-free survival (94.2% vs. 82.5%, P = 0.120). The total stented length (hazard ratio [HR] 1.01, 95% confidence interval [CI] 1.00-1.01, P = 0.011) and age (HR 0.94, 95% CI 0.90-1.00, P = 0.035) were independent predictors of restenosis.
The spot stenting appears to be more favorable than the long stenting in terms of primary patency and TLR-free survival, although the difference was not statistically significant. The stented length was an independent predictor of restenosis.
对于长段股腘动脉病变，最佳的支架置入策略仍不明确。已有研究表明，较长的支架长度与再狭窄风险增加相关。我们旨在比较局部支架置入与长段支架置入治疗股腘动脉疾病的疗效。
本研究设计为一项多中心随机对照试验，比较局部支架置入与长段初次支架置入治疗股腘动脉病变的即刻和中期结果。共125例患者按1:1随机分为局部支架置入组（n = 59）或长段支架置入组（n = 66）。
所有病变均采用自膨式裸镍钛合金支架治疗。除男性性别和当前吸烟者外，两组间基线临床和病变特征相似。平均病变长度为24.1±8.8 cm。所有患者均取得技术成功。两组间1年主要通畅率和无靶病变血运重建（TLR）生存率无显著差异。然而，局部支架置入组在主要通畅率（86.1%对72.7%，P = 0.158）和无TLR生存率（94.2%对82.5%，P = 0.120）方面有更高的趋势。总支架长度（风险比[HR]1.01，95%置信区间[CI]1.00 - 1.01，P = 0.011）和年龄（HR 0.94，95%CI 0.90 - 1.00，P = 0.035）是再狭窄的独立预测因素。
尽管差异无统计学意义，但在主要通畅率和无TLR生存率方面，局部支架置入似乎比长段支架置入更具优势。支架长度是再狭窄的独立预测因素。
