Abstract 3835: Infrapopliteal Drug-Eluting Stents for Chronic Limb Ischemia
OBJECTIVES: We report our experience with the elective placement of below-knee, drug-eluting stents (DES) in patients (P) with chronic limb ischemia (CLI).
BACKGROUND: Infrapopliteal percutaneous transluminal angioplasty has been associated with a lower rate of procedural success and high rate of restenosis due to the small size of the tibial vessels and the prevalence of calcified and diffuse atherosclerotic disease. Prior published data reports one-year patency rates below 50%. There has been reluctance to use bare metal stents, other than in bail-out situations, due to a perceived increased risk of restenosis. DES have markedly reduced restenosis in the coronary vasculature, but data supporting the use of these devices below the knee are scarce.
METHODS: Elective placement of DES in infrapopliteal lesions was performed on 10 P with severe (≥ Fontaine Stage IIb) claudication (n=1) or limb-threatening ischemia (n= 9) (rest pain, non-healing ulcers and gangrene).
RESULTS: Lesion length was 25 ± 11 mm and total stent length was 38 ± 19 mm. The primary endpoint, clinical patency measured by freedom from target vessel revascularization (TVR), was 90% (1/10) at a mean of 10 ± 5 months of follow-up. The single patient requiring TVR experienced subacute thrombosis (SAT) at 3 weeks necessitating emergent percutaneous revascularization. There were no other recurrences of CLI. Clinically-driven angiographic follow-up in 2 P at 4 months and 16 months confirmed tibial DES patency in both cases.
CONCLUSIONS: The use of below-knee DES is feasible and appears to be safe in our small series of complex infrapopliteal lesions causing CLI. The occurrence of a single case of SAT warrants continued observation in this cohort. Prospective clinical trials will be necessary to confirm the benefits and justify the costs of this strategy for treating patients with infrapopliteal culprit lesions and CLI.