Clinical study
Outcomes of Covered Kissing Stent Placement Compared with Bare Metal Stent Placement in the Treatment of Atherosclerotic Occlusive Disease at the Aortic Bifurcation

https://doi.org/10.1016/j.jvir.2010.02.032Get rights and content

Purpose

To review the outcomes with the use of balloon-expandable covered iliac kissing stents as compared with bare metal stents in the treatment of atherosclerotic disease at the aortic bifurcation.

Materials and Methods

A review of consecutive patients from a single institution with atherosclerotic occlusive disease at the aortic bifurcation treated with balloon-expandable kissing stents was performed between January 1, 2002, and September 1, 2007. Fifty-four patients were identified and divided into two groups: those with bare metal stents and those with covered stents. Technical and clinical success (Fontaine classification), complications, and patency at follow-up were documented.

Results

Twenty-six patients (17 men, nine women; mean age, 61 years; age range, 39–79 years) received covered stents and 28 patients (15 men, 13 women; mean age, 61 years; age range, 38–82 years) received bare metal stents. Technical success was achieved in 100% of patients in both groups. Major complications occurred in three of the 26 (11%) with covered stents (P = .66) and two of the 28 patients (7%) with bare metal stents. The median follow-up was 21 months (20 months for covered stents vs 25 months for bare metal stents; range, 1–62 months). Twenty-two of the 26 patients (85%) with covered stents had sustained improvement in clinical symptoms during the follow-up period compared with 15 of the 28 patients (54%) with bare metal stents (P = .02). Primary patency rates at 1 and 2 years were 92% and 92%, respectively, for covered stents and 78% and 62% for bare metal stents (P = .023).

Conclusions

The use of covered balloon-expandable kissing stents for atherosclerotic aortic bifurcation occlusive disease provides superior patency at 2 years as compared with bare metal balloon-expandable stents.

Section snippets

Materials and Methods

A retrospective review of consecutive patients from a single institution with atherosclerotic occlusive disease at the aortic bifurcation treated with kissing balloon-expandable iliac kissing stents was undertaken for procedures performed between January 1, 2002, and September 1, 2007, by using a procedural database (Hi-IQ; ConexSys, Albion, Rhode Island). Human investigation review board approval was obtained for this study. Electronic medical records were reviewed for patient demographics,

Results

Fifty-four consecutive patients were identified and divided into two groups: those with covered stents and those with bare metal stents. Twenty-six patients (17 men, 9 women; mean age, 61 years; age range, 39–79 years) received covered stents–-all of which were placed after November 2004. Twenty-eight patients (15 men, 13 women; mean age, 61 years; age range, 38–82 years) received bare metal stents–-all but four were placed before November 2004 (Table 1). The demographic data and risk factors

Discussion

The management of symptomatic atherosclerotic occlusive disease of the iliac arteries has been dramatically altered by the use of permanent metal endoprostheses (stents). Clinical success rates of 70%–92% at 2 years have been reported for bare metal stents in the CIA (21, 22). Patients with CIA origin occlusive lesions, with or without adjacent distal aortic disease, represent a complex subgroup of patients because of the technical challenges associated with stent placement and the variable

Acknowledgment

The authors acknowledge the tireless efforts of Tammy Amos in the preparation of this manuscript.

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