Myriam Ammi1, Samir Henni2, Lucie Salomon Du Mont3, Nicla Settembre4, Hélène Loubiere1, Jonathan Sobocinski5, Yann Gouëffic6, Patrick Feugier7, Ambroise Duprey8, Robert Martinez9, Michel Bartoli10, Raphael Coscas11, Xavier Chaufour12, Adrien Kaladji13, Eugenio Rosset14, Pierre Abraham2, Jean Picquet1. 1. 1 Service de Chirurgie Vasculaire, CHU Angers, France. 2. 2 Service de Médecine Vasculaire, CHU Angers, France. 3. 3 Service de Chirurgie Vasculaire, CHU Besançon, France. 4. 4 Service de Chirurgie Vasculaire, CHU Nancy, France. 5. 5 Service de Chirurgie Vasculaire, CHU Lille, France. 6. 6 Service de Chirurgie Vasculaire, CHU Nantes, France. 7. 7 Service de Chirurgie Vasculaire, CHU Lyon, France. 8. 8 Service de Chirurgie Vasculaire, CHU Saint Etienne, France. 9. 9 Service de Chirurgie Vasculaire, CHU Tours, France. 10. 10 Service de Chirurgie Vasculaire, Assistance Publique-Hôpitaux de Marseille, France. 11. 11 Service de Chirurgie Vasculaire, Hôpital Ambroise Paré, Paris, France. 12. 12 Service de Chirurgie Vasculaire, CHU Toulouse, France. 13. 13 Service de Chirurgie Vasculaire, CHU Rennes, France. 14. 14 Service de Chirurgie Vasculaire, CHU Clermont Ferrand, France.
Abstract
PURPOSE: To determine any difference between bare metal stents (BMS) and balloon-expandable covered stents in the treatment of innominate artery atheromatous lesions. MATERIALS AND METHODS: A multicenter retrospective study involving 13 university hospitals in France collected 93 patients (mean age 63.2±11.1 years; 57 men) treated over a 10-year period. All patients had systolic blood pressure asymmetry >15 mm Hg and were either asymptomatic (39, 42%) or had carotid (20, 22%), vertebrobasilar (24, 26%), and/or brachial (20, 22%) symptoms. Innominate artery stenosis ranged from 50% to 70% in 4 (4%) symptomatic cases and between 70% and 90% in 52 (56%) cases; 28 (30%) lesions were preocclusive and 8 (9%) were occluded. One (1%) severely symptomatic patient had a <50% stenosis. Demographic characteristics, operative indications, and procedure details were compared between the covered (36, 39%) and BMS (57, 61%) groups. Multivariate analysis was performed to determine relative risks of restenosis and reinterventions [reported with 95% confidence intervals (CI)]. RESULTS: The endovascular procedures were performed mainly via retrograde carotid access (75, 81%). Perioperative strokes occurred in 4 (4.3%) patients. During the mean 34.5±31.2-month follow-up, 30 (32%) restenoses were detected and 13 (20%) reinterventions were performed. Relative risks were 6.9 (95% CI 2.2 to 22.2, p=0.001) for restenosis and 14.6 (95% CI 1.8 to 120.8, p=0.004) for reinterventions between BMS and covered stents. The severity of the treated lesions had no influence on the results. CONCLUSION: Patients treated with BMS for innominate artery stenosis have more frequent restenoses and reinterventions than patients treated with covered stents.
PURPOSE: To determine any difference between bare metal stents (BMS) and balloon-expandable covered stents in the treatment of innominate artery atheromatous lesions. MATERIALS AND METHODS: A multicenter retrospective study involving 13 university hospitals in France collected 93 patients (mean age 63.2±11.1 years; 57 men) treated over a 10-year period. All patients had systolic blood pressure asymmetry >15 mm Hg and were either asymptomatic (39, 42%) or had carotid (20, 22%), vertebrobasilar (24, 26%), and/or brachial (20, 22%) symptoms. Innominate artery stenosis ranged from 50% to 70% in 4 (4%) symptomatic cases and between 70% and 90% in 52 (56%) cases; 28 (30%) lesions were preocclusive and 8 (9%) were occluded. One (1%) severely symptomatic patient had a <50% stenosis. Demographic characteristics, operative indications, and procedure details were compared between the covered (36, 39%) and BMS (57, 61%) groups. Multivariate analysis was performed to determine relative risks of restenosis and reinterventions [reported with 95% confidence intervals (CI)]. RESULTS: The endovascular procedures were performed mainly via retrograde carotid access (75, 81%). Perioperative strokes occurred in 4 (4.3%) patients. During the mean 34.5±31.2-month follow-up, 30 (32%) restenoses were detected and 13 (20%) reinterventions were performed. Relative risks were 6.9 (95% CI 2.2 to 22.2, p=0.001) for restenosis and 14.6 (95% CI 1.8 to 120.8, p=0.004) for reinterventions between BMS and covered stents. The severity of the treated lesions had no influence on the results. CONCLUSION:Patients treated with BMS for innominate artery stenosis have more frequent restenoses and reinterventions than patients treated with covered stents.