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Ann Vasc Surg. 2017 Aug;43:166-175. doi: 10.1016/j.avsg.2016.10.058. Epub 2017 Mar 11.

Bare Metal Versus Paclitaxel-Eluting Stents for Long Femoropopliteal Lesions: Prospective Cohorts Comparison Using a Propensity Score-Matched Analysis.

Author information

1
Department of Vascular Surgery, CHU (University Hospital Centre) Nantes, l'institut du thorax, service de chirurgie vasculaire (Institut du Thorax), Nantes, France.
2
Department of Cardiothoracic and Vascular Surgery, CHU de Rennes, Rennes, France.
3
CHU Nantes, l'institut du thorax, centre d'investigation clinique (Clinical Investigation Centre), Nantes, France; Inserm UMR1087, l'institut du thorax, Nantes, France; CNRS, UMR 6291, Nantes, France; Université de Nantes, Nantes, France.
4
Laboratory of Bone Resorption Physiopathology, Inserm UMR-957, Nantes, France.
5
Department of Vascular Surgery, CHU (University Hospital Centre) Nantes, l'institut du thorax, service de chirurgie vasculaire (Institut du Thorax), Nantes, France; Université de Nantes, Nantes, France; Laboratory of Bone Resorption Physiopathology, Inserm UMR-957, Nantes, France. Electronic address: yann.goueffic@chu-nantes.fr.

Abstract

BACKGROUND:

The study aims to compare outcomes of primary stenting of long femoropopliteal (FP) lesions with bare metal stent (BMS) versus paclitaxel eluting stent (PES).

METHODS:

In a single centre study, we established 2 consecutive and prospective cohorts with TASC C/D FP de novo lesions. The inclusion and exclusion criteria were similar. Bare metal stent (LifeStent®, Bard Peripheral) and PES (Zilver® PTX®, Cook Peripheral Vascular) were implanted. Prospective clinical and morphological follow-ups were carried out at 1, 3, 6, 12, and 18 months. Propensity score (inverse probability of treatment weighted method) stratification was used to minimize bias.

RESULTS:

In total, 110 limbs were treated (STELLA: n = 62; STELLA PTX: n = 48). We noted some difference between both cohorts regarding type 2 diabetes (P = 0.05), vitamin K antagonist use (P = 0.05), and angiotensin II receptor blocker use (P = 0.002). More stents were implanted in the STELLA PTX cohort (P < 0.0013). At 12 months, in univariate analysis, freedom from target lesion revascularization (TLR) was higher in the STELLA cohort (P = 0.005). No differences were found between both cohorts in terms of primary sustained clinical improvement (P = 0.25), primary patency (P = 0.07), and survival (P = 0.79). With the propensity score, no difference was observed in terms of primary sustained clinical improvement (P = 0.79), freedom from TLR (P = 0.59), and primary patency (P = 0.69). With Cox logistic regression, the number of implanted stents influenced the primary sustained clinical improvement, the freedom from TLR, and the primary patency.

CONCLUSIONS:

Paclitaxel-eluting stents do not seem to provide benefits in terms of clinical and morphological outcomes for TASC C/D lesions compared to BMS.

PMID:
28300676
DOI:
10.1016/j.avsg.2016.10.058
[Indexed for MEDLINE]

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