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Clinical outcomes of balloon angioplasty alone versus nitinol stent implantation in patients with small femoropopliteal artery disease: Observations from the Retrospective Multicenter Analysis for Femoropopliteal Stenting (REAL‐FP)
Author(s) -
Kamioka Norihiko,
Soga Yoshimitsu,
Kuramitsu Shoichi,
Iida Osamu,
Hirano Keisuke,
Suzuki Kenji,
Kawasaki Daizo,
Yamaoka Terutoshi,
Suematsu Nobuhiro,
Shintani Yoshiaki,
Miyashita Yusuke,
Takahashi Hiroki,
Tsuchiya Taketsugu,
Shinozaki Norihiko,
Okazaki Shinya,
Ando Kenji
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27192
Subject(s) - medicine , angioplasty , restenosis , balloon , stent , hazard ratio , popliteal artery , retrospective cohort study , surgery , radiology , confidence interval , cardiology
Objectives We sought to assess whether balloon angioplasty (BA) alone for small femoropopliteal disease improved the outcome following endovascular therapy as compared with stent implantation. Background The optimal strategy of endovascular therapy for small vessel arteries in femoropopliteal disease remains unclear. Methods We performed a multicenter retrospective analysis of 337 consecutive patients (371 limbs) with femoropopliteal arteries 4.0 mm or less in diameter and 150 mm or less in length. Results Cumulative 3‐year incidence of primary patency was significantly higher in the BA group than in the stent group (53.8% vs. 34.2%, P = 0.002). While assisted‐primary patency and freedom from any major adverse limb events were also significantly higher in the BA group than in the stent group (70.9% vs. 44.2%, P < 0.001 and 60.6% vs. 36.4%, P = 0.001, respectively), secondary patency did not significantly differ between the two groups (86.9% vs. 86.9%, P = 0.67). Predictors of restenosis were diabetes mellitus (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.14–2.31; P = 0.01), no administration of cilostazol (HR, 1.50; 95% CI, 1.07–2.13; P = 0.02), stent implantation (HR, 1.68; 95% CI, 1.15–2.41; P = 0.01), and lesion length >75.0 mm(HR, 2.09; 95% CI, 1.50–2.92; P < 0.001). Conclusions Lesions in small (<4.0 mm diameter) FP vessels demonstrated better primary patency at 3 years when successfully treated with balloon angioplasty alone as opposed to routine or bailout stenting. This difference was especially pronounced for lesions 75 to 150 mm in length.