Endovascular treatment of peripheral artery disease with expanded PTFE-covered nitinol stents: interim analysis from a prospective controlled study.

PURPOSE: Current covered peripheral stent designs have significant drawbacks in terms of stent delivery characteristics and flexibility. The aim of this study was to analyze the technical performance, safety and initial clinical efficacy of expanded polytetrafluoroethylene (PTFE)-covered nitinol stents for arteriosclerotic peripheral artery disease. METHODS: Eighty-two patients underwent implantation of PTFE-covered nitinol stents for iliac and/or femoral obstructions. The study was conducted prospectively in seven European centers and one Canadian center. Patients were controlled clinically and by duplex ultrasound follow-up. Data up to discharge were collected in 79 patients. Seventy-four patients have thus far received 1 month follow-up and 32 patients, 6 month follow-up examinations. RESULTS: The average lesion length measured 47 mm for the common and external iliac arteries and 50 mm for the femoral arteries. The mean severity of the stenoses was reduced from 94% to 4% in the iliac arteries and from 98% to 7% in the femoral arteries after stent placement and dilatation. One device deviation (inadvertent stent misplacement) and one puncture-related severe adverse event with formation of a pseudoaneurysm occurred. There were occlusions of the stent in five patients. No infections were noticed. CONCLUSION: The interim analysis of this trial using PTFE-covered nitinol stents indicates that a strategy using primary implantation of this stent type is technically feasible, has an acceptable safety profile and is effective from a short-term perspective.

[Endovascular implantation of stent-grafts in the thoracic aorta -mid-term results of a prospective controlled study]. / Endovaskuläre Implantation von Stent-Grafts in die Aorta thoracica - Mittelfristige Ergebnisse einerprospektiven kontrollierten Studie.

PURPOSE: To evaluate the effectiveness and safety of endovascular treatment of various descending thoracic aortic pathologies with covered stent-grafts as an alternative to open surgery. METHODS: Among 16 patients (5 type B dissections, 5 contained ruptures, 3 aneurysms of the descending aorta, 1 thoraco-abdominal aneurysm, 1 mural thrombosis, 1 patch aneurysm) treated between November 1997 and November 2000, eight patients received Talent stent-grafts and another 8 patients underwent a Gore-TAG stent-graft implantation. A clinical follow-up and control CT scans were obtained after the procedure and then at six-month intervals. RESULTS: Deployment of the stent-grafts was technically successful in all cases. Sufficient aortic reconstruction was achieved in all but one patient who needed surgical treatment. One patient died two days after the procedure from aortic rupture due to retrograde type A dissection. Another patient died 19 months after the procedure from an unknown cause. There was no occurrence of distal embolization, paralysis or infection. During follow-up, all patients remained free from recurrence or late complications of their disease. CONCLUSION: Endoluminal treatment of thoracic aortic pathologies with covered stent-grafts appears to be a safe and feasible method with at least mid-term efficacy.

[Economical analyses in interventional radiology]. / Okonomische Analysen in der Interventionellen Radiologie.

Considerations about the relation between benefit and expenses are also gaining increasing importance in interventional radiology. This review aims at providing a survey about the published data concerning economical analyses of some of the more frequently employed interventions in radiology excluding neuroradiological and coronary interventions. Because of the relative scarcity of literature in this field, all identified articles (n = 46) were included without selection for methodological quality. For a number of radiological interventions the cost-effectiveness has already been demonstrated, e. g., PTA of femoropopliteal and iliac artery stenoses, stenting of renal artery stenoses, placement of vena-cava filters, as well as metal stents in malignant biliary and esophageal obstructions. Conflicting data exist for the treatment of abdominal aortic aneurysms. So far, no analysis could be found that directly compares bypass surgery versus PTA + stent in iliac arteries.

New strategies in platelet inhibition in noncoronary interventions.

Thrombembolic complications frequently occur during and after endovascular procedures because of associated arterial injury and thrombotic characteristics of implanted devices such as stents. New strategies in platelet aggregation inhibition are now available blocking the final and common pathway of platelet aggregation, the glycoprotein IIb/IIIa receptor. This treatment modality seems to be more effective for prophylaxis and prevention of thrombembolic complications than standard antiplatelet therapy. Most of the data provided for glycoprotein IIb/IIIa receptor blockade are derived from studies of coronary interventions. This report reviews the pharmacodynamic differences of classic and new drugs for platelet inhibition and the basic considerations for antiplatelet therapy in noncoronary interventions.