Soukas Peter, Becker Matthew, Stark Karl, Tepe Gunnar
Lifespan Cardiovascular Institute, the Miriam Hospital, Alpert School of Medicine of Brown University, Providence, Rhode Island.
Lake Erie College of Medicine Heart and Vascular Institute, Cardiovascular Medicine, Interventional Cardiology and Cardiac Catheterization Laboratory, Ambulatory Surgical Vascular Institute, Erie, Pennsylvania.
J Soc Cardiovasc Angiogr Interv. 2023 Feb 20;2(3):100598. doi: 10.1016/j.jscai.2023.100598. eCollection 2023 May-Jun.
The study objective was to assess the postmarket safety and effectiveness of the GORE VIABHAN endoprosthesis with heparin bioactive surface for the treatment of in-stent restenosis (ISR) of the superficial femoral artery (SFA).
A prospective, single-arm, international study enrolled patients at 23 sites from October 2015 to April 2018. Patients with ≥50% ISR or occlusions in the SFA, Rutherford categories 2-5, and at least 1 patent runoff vessel were eligible. The primary effectiveness endpoint was primary patency at 12 months. The primary safety endpoint was the rate of device- or procedure related serious adverse events at 30 days.
One hundred and eight patients were enrolled, and 86 were included for analysis through 3 years (mean age, 70.0 ± 10.4 years; 48.8% female). The mean core lab reported lesion length was 12.4 ± 6.92 cm (29.1% occlusions); 10.5% presented with chronic limb-threatening ischemia, and 81.9% of lesions were Tosaka II and II. Acute procedural success was 98.8%. Freedom from device- or procedure-related SAE was 96.5% through 30 days. At 1-year, primary, primary-assisted, and secondary patency rates were 74.7%, 80.4%, and 98.4%, respectively. Freedom from target lesion revascularization was 84.8%, 74.6%, and 65.0% at 1, 2, and 3 years, respectively. Per core laboratory assessment, no major amputations or device failures occurred through 3 years. At 3 years, 80.4% of patients had ≥ 1 Rutherford category improvement.
The VIABAHN endoprosthesis is a safe and effective treatment for long and complex lesions in the SFA through 3 years.
本研究的目的是评估具有肝素生物活性表面的GORE VIABHAN血管内支架治疗股浅动脉(SFA)支架内再狭窄(ISR)的上市后安全性和有效性。
一项前瞻性、单臂、国际研究于2015年10月至2018年4月在23个地点招募患者。SFA中ISR≥50%或闭塞、卢瑟福分级为2 - 5级且至少有1条通畅流出血管的患者符合入选标准。主要有效性终点是12个月时的原发性通畅率。主要安全性终点是30天时与器械或手术相关的严重不良事件发生率。
共纳入108例患者,3年内86例纳入分析(平均年龄70.0±10.4岁;48.8%为女性)。核心实验室报告的平均病变长度为12.4±6.92 cm(29.1%为闭塞性病变);10.5%表现为慢性肢体威胁性缺血,81.9%的病变为托萨卡II级和III级。急性手术成功率为98.8%。30天时与器械或手术相关的严重不良事件发生率为96.5%。1年时,原发性、原发性辅助性和继发性通畅率分别为74.7%、80.4%和98.4%。1年、2年和3年时靶病变血管重建率分别为84.8%、74.6%和65.0%。根据核心实验室评估,3年内未发生重大截肢或器械故障。3年时,80.4%的患者卢瑟福分级至少改善1级。
GORE VIABHAN血管内支架在3年内是治疗SFA长而复杂病变的安全有效方法。