Study at SIR Shows Safety and Effectiveness of Stenting CTOs of Mesenteric Arteries

April 14, 2013—The Society of Interventional Radiology (SIR) announced the presentation of a study at SIR's 38th Annual Scientific Meeting in New Orleans, Louisiana, demonstrating that stenting reopens completely blocked bowel arteries. Chronic mesenteric ischemia can cause dangerous weight loss, malnourishment, and death because the intestines are prevented from receiving the oxygen-rich blood they require to digest food, noted SIR.

“Stenting blocked mesenteric arteries saves lives,” commented the study's lead investigator Daniel A. Leung, MD, Program Director of Vascular Interventional Radiology for the Christiana Care Health System in Wilmington, Delaware. In the SIR press release, Dr. Leung noted, “Open surgery has traditionally been the primary treatment for patients with a 100% blocked mesenteric artery, but that is associated with high mortality rates and a long recovery, and many patients don't qualify for surgery due to poor health. Our research found that stenting the main mesenteric artery supplying the bowel can almost immediately resolve patients' symptoms—even when that artery is 100% blocked—allowing them to recover rapidly. And those results last.”

“Stenting of Superior Mesenteric Artery Chronic Total Occlusions in Patients With Chronic Mesenteric Ischemia: Technical and Clinical Outcomes” by Christopher Grilli, DO, et al was presented as Abstract 16 during the Arterial Interventions: Stents and Dissection session at the SIR meeting on April 14.

According to the study abstract, endovascular treatment of chronic mesenteric arterial stenosis is well accepted but management of chronic total occlusions (CTO) remains controversial, with historical mainstays of treatment consisting of bypass or endarterectomy. The investigators' goal was to evaluate the clinical and technical outcomes of endovascular recanalization and stenting of CTOs of the superior mesenteric artery (SMA).

The investigators performed a retrospective review of 46 patients (18 male, 28 female) who underwent endovascular stenting of CTOs of the SMA between February 2008 and July 2012. All patients had symptoms of chronic mesenteric ischemia. Procedural and follow-up data were collected for assessment of technical success, safety, and outcomes. Technical success was defined as the ability to traverse and stent the SMA occlusion without significant residual stenosis. Patency and freedom from symptom recurrence were calculated by Kaplan-Meier analysis.

As summarized in the study abstract, technical success was achieved in 40 of 46 patients (87%). Twelve patients underwent concurrent stenting of the celiac artery. Of the six technical failures, two were referred for bypass, three underwent celiac artery stenting, and one was lost to follow-up. Within 24 hours of the procedure, complete symptomatic relief was reported by 39 of 40 patients (97%), while one patient (3%) reported partial improvement. No patients reported stable or worsening of symptoms.

Imaging follow-up (22 ultrasound, eight computed tomography angiography) was obtained in 30 of 40 (75%) patients, with a mean follow-up of 11.2 months. Kaplan-Meier analysis revealed a primary patency of 100% at 3 months, 96% at 6 months, 80% at 1 year, and 72% at 2 years. Symptomatic recurrences, which were observed in five patients, correlated to restenosis/reocclusion on imaging. All five patients underwent successful assisted or secondary percutaneous transluminal angioplasty and/or stenting procedures. Kaplan-Meier analysis of freedom from symptom recurrence showed primary and assisted rates of 80% and 100% at 1 year, and 77% and 97% at 2 years. There were three (7%) minor access-related complications and no major complications, reported the investigators.

From this experience, the investigators concluded that endovascular stenting of CTOs of the SMA is a safe and effective procedure with an acceptable technical success rate and excellent midterm clinical outcomes.