drug eluting or absorbable stents versus bare metal stents in peripheral artery disease l.
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Drug-eluting or absorbable stents versus bare-metal stents in peripheral artery disease. Giuseppe Biondi Zoccai Divisione di Cardiologia, Università di Torino gbiondizoccai@gmail.com. Scope of the problem. Biondi Zoccai et al, G Ital Cardiol 2009. Scope of the problem - II.

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drug eluting or absorbable stents versus bare metal stents in peripheral artery disease

Drug-eluting or absorbable stents versus bare-metal stents in peripheral artery disease

Giuseppe Biondi Zoccai

Divisione di Cardiologia, Università di Torino

gbiondizoccai@gmail.com

scope of the problem
Scope of the problem

Biondi Zoccai et al, G ItalCardiol 2009

why stents
Why stents?
  • Balloon-only angioplasty is fraught with:
    • Elastic recoil
    • Flow-limiting dissection
    • Constrictive remodeling
    • Neointimal hyperplasia
    • Biocompatibility
  • Stents may address these issues
why stents7
Why stents?
  • Balloon-only angioplasty is fraught with:
    • Elastic recoil
    • Flow-limiting dissection
    • Constrictive remodeling
    • Neointimal hyperplasia
    • Biocompatibility
  • Stents may address these issues

BMS

why stents8
Why stents?
  • Balloon-only angioplasty is fraught with:
    • Elastic recoil
    • Flow-limiting dissection
    • Constrictive remodeling
    • Neointimal hyperplasia
    • Biocompatibility
  • Stents may address these issues

DES

why stents9
Why stents?
  • Balloon-only angioplasty is fraught with:
    • Elastic recoil
    • Flow-limiting dissection
    • Constrictive remodeling
    • Neointimal hyperplasia
    • Biocompatibility
  • Stents may address these issues

ABS

explosion of data on stents for pad
Explosion of data on stents for PAD

PubMed queried on 7 December 2009: stent* AND (femoral OR popliteal OR femoropopliteal OR "femoro-popliteal" OR tibial OR "infra-popliteal" OR infrapopliteal OR (critical AND limb AND ischemia)) NOT (vein OR venous)

iliac stenting just in bail out
Iliac stenting: just in bail-out?

DutchIliacStent Trial: randomized trial of stenting vs balloon-only PTA (withstentifcomplications or meangradient >10 mm Hg)*

*stentingfinallyperformed in 40% ofptsrandomizedto PTA

Routine stenting

PTA with

selective stenting

Klein et al, Radiology 2006

the absolute trial absolute stent
The ABSOLUTE trial: Absolute stent

Schillinger et al, Circulation 2007

the sirocco ii trial sirolimus eluting smart stent freedom from restenosis
The SIROCCO II trial: Sirolimus-eluting Smart stentFreedom from restenosis

71.8%

67.2%

Duda et al, J VascIntervRadiol 2005

repeat pta after btk stenting
Repeat PTA after BTK stenting

Biondi-Zoccai et al, J EndovascTher 2009

what about absorbable stents
What about absorbable stents?

BASELINE

6 MONTHS

POST-AMS

Bosiers et al, CardiovascInterventRadiol 2009

what about absorbable stents21
What about absorbable stents?

6-month angiographic patency rate:

31.8% for AMS vs. 58.0% for PTA (p=0.013)

Bosiers et al, CardiovascInterventRadiol 2009

take home messages
Take home messages
  • Primary stenting with self-expandable bare-metal stents is considered by many the standard of care for iliac and superficial femoral arteries
  • Bail-out drug-eluting stenting is beneficial for infra-popliteal lesions
  • Conversely, stents (any) should be avoided in common femoral or popliteal arteries
  • Further clinical evidence is needed before deciding on the role of absorbable stents and femoral drug-eluting stents
slide23

Thank you for your attentionFor any correspondence: gbiondizoccai@gmail.comFor these and further slides on these topics feel free to visit the metcardio.org website:http://www.metcardio.org/slides.html

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