Thomas Martin Carr MD, Presenter: Nothing to Disclose

John F. Angle MD, Abstract Co-Author: Research grant, Atrium Medical Corporation Speaker, Siemens AG Consultant, AGA Medical Corp

Alan Hiyoshi Matsumoto MD, Abstract Co-Author: Speakers Bureau, W. L. Gore & Associates, Inc Speakers Bureau, Cook Group, Inc Speakers Bureau, Medtronic, Inc Advisory Board, Crux Biomedical, Inc Research grant, Talecris Biotherapeutics, Inc Research grant, Medtronic, Inc Research grant, W. L. Gore & Associates, Inc Research grant, Cook Group Incorporated Research grant, Siemens AG Consultant, Siemens AG Consultant, C. R. Bard, Inc Consultant, AGA Medical Corp Data Monitoring Safety Board, CH-Werfen

To evaluate the clinical efficacy of balloon-expandable covered stent placement compared to standard therapy with noncovered stent placement for the treatment of iliac artery disease.

Balloon-expandable covered stents were routinely used at one institution beginning beginning in November, 2004 for treatment of iliac artery disease. A retrospective review of covered stent placements through December 2007 was performed. Cases with placement of noncovered balloon-expandable stents were also identified at the same institution between 2004 and 2007. Review of the medical records was performed to determine ABI and clinical stage of disease prior to treatment and at followup in both populations. Technical success was defined as < 30% residual stenosis in the treated artery. Clinical success was determined by an increase of at least 0.15 from the pretreatment ABI. Primary patency of the stents was gauged at followup less than a 50% stenosis of the stent or within 1 cm of the stent on angiography or CT angiography, for those cases where imaging was available.

Balloon-exandable covered stents were placed in 50 patients for treatment of 69 iliac arteries, and balloon-expandable noncovered stents were placed in 40 patients for treatment of 53 iliac arteries. Average pretreatment ABI for the covered and noncovered groups was 0.68 and 0.66, respectively. Average posttreatment and followup ABIs were 0.85 for the covered stents and 0.82 for the noncovered stents. Of the limbs treated with covered stents, 46% met criteria for clinical success and 90% met criteria for patency at followup imaging. For limbs treated with noncovered stents, 43% met criteria for immediate clinical success, and 87% met criteria for patency at followup imaging. The mean followup interval for both groups was similar at 12.1 months for covered stents and 15.4 months for the noncovered stents. Complication rates associated with treatment were similar in both groups as well (2.8% for covered vs 3.8% for noncovered).  

Clinical outcomes after placement of covered stents for iliac artery disease are comparable to controls treated with non-covered stents, with slightly better clinical efficacy in our population.

Covered stents are at least as effective as noncovered stents in the treatment of iliac artery disease and may offer additional benefits, particularly in patients with high-risk atheromatous plaques.

Carr, T, Angle, J, Matsumoto, A, Covered versus Noncovered Balloon Expandable Stent Placement for the Treatment of Iliac Artery Disease.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6005921.html