BTK Stents Evaluated to Treat Intraprocedural Distal Embolization After Femoropopliteal Angioplasty
August 9, 2017—In CardioVascular and Interventional Radiology, Miltiadis Krokidis, MD, et al published findings from a study that assessed the use of below-the-knee stents as a bailout for conventional methods to treat intraprocedural distal embolization during femoropopliteal angioplasty (2017;40;1155–1163).
The investigators retrospectively reviewed 1,485 femoropopliteal angioplasty procedures that were performed in their center during a 4-year period. They identified and analyzed 12 cases (< 1%) in which distal embolization required further intervention. In all cases, lesions were chronic and 75% had critical limb ischemia (CLI). The target vessel was the superficial femoral artery (SFA) in all patients, 50% of whom had a long (> 10 cm) occlusion. Three-vessel run-off was present in only 25% of cases.
As summarized in CardioVascular and Interventional Radiology, those who received a stent as an attempt at limb salvage were analyzed. Outcome measures were technical success, clinical success, and procedure-related complications. The investigators also performed a multivariate regression analysis of the factors related to stenting.
Recanalization with aspiration, thrombolysis, or angioplasty offered a satisfactory result in 41% of the cases with distal embolization. Conventional methods were ineffective in 59% of cases, a stent was deployed in 85% of cases, and surgical embolectomy was required in 15% of cases. The technical and clinical success of the stent cases was 100%, without any procedure-related complications.
The investigators found that there was significance (P < .05) between CLI and stenting. Single-vessel run-off has also shown a positive trend (P = .88).
Stents appear to be a valid salvage option for infragenicular distal embolization when conventional methods fail, and the likelihood of having to use a stent is higher for patients with CLI and a single-vessel run-off, concluded the investigators in CardioVascular and Interventional Radiology.