LITERATURE HIGHLIGHTS: Nitinol Stents and Balloon PTA Compared in SFA Lesions

December 1, 2009—In a study published in Catheterization and Cardiovascular Interventions, Petra Dick, MD, et al reinvestigated whether primary nitinol stenting is associated with a morphologic and clinical benefit when compared with percutaneous transluminal angioplasty (PTA) with optional stenting in intermediate- length lesions (2009;74:1090–1095). The investigators noted that recent randomized trials investigating stent implantation compared to balloon angioplasty to treat superficial femoral artery (SFA) disease have given divergent results in short (mean, 5 cm) and intermediate (mean, 10 cm) lesions.

As detailed by the investigators, they randomly assigned 73 patients with severe claudication or chronic limb ischemia and an SFA stenosis or occlusion (average, 8 cm long [range, 3–20 cm]) to primary stent implantation (n = 34) or PTA (n = 39). Restenosis > 50% and clinical outcome were assessed at 3, 6, and 12 months postintervention.

The investigators reported that the average length of the treated segments was 98 ± 54 mm and 71 ± 43 mm in the stent and PTA groups (P = .011), respectively. In the PTA group, secondary stenting was performed in 10 of 39 patients (26%) due to a suboptimal result after balloon dilation. Restenosis rates in the stent and PTA groups were 21.9% versus 55.6% (P = .005) at 6 months by computed tomographic angiography, 2.9% versus 18.9% (P = .033), 18.2% versus 50% (P = .006), and 34.4% versus 61.1% (P = .028) at 3, 6, and 12 months by sonography, respectively. Clinically, patients in the stent group reported a significantly higher maximum walking capacity compared to the PTA group at 6 and 12 months.

The investigators concluded that in this randomized multicenter trial, primary stenting with a self-expanding nitinol stent for treating intermediate-length SFA disease resulted in morphologically and clinically superior midterm results compared to balloon angioplasty with optional secondary stenting.