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Covered Versus Bare-metal Stents for Iliac Occlusive Disease

Paulo Eduardo Ocke Reis1and Christian-Alexander Behrendt2

1Department of Specialized and General Surgery, Fluminense Federal University, Rio de Janeiro, Brazil

2Department of Vascular Medicine, Work Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

*Corresponding Author:
Paulo Eduardo Ocke Reis
Department of Specialized and General Surgery
Fluminense Federal University
Rio de Janeiro, Brazil
Tel: +55 21 2629-5000
E-mail:[email protected]

Received date: August 08, 2019 Accepted date: August 12, 2019 Published date: August 19, 2019

Citation: Ocke Reis PE, Behrendt CA (2019) Covered Versus Bare-metal Stents for Iliac Occlusive Disease. J Vasc Endovasc Therapy Vol.4 No.3:15

Copyright: ©2019 Ocke Reis PE, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

 

 
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Abstract

Editorial

Since covered stents with polytetrafluoroethylene (PTFE) have been associated with less neo-intimal hyperplasia, leading to lower restenosis rates, several authors have published comparative data of covered versus bare-metal stents for iliac occlusive disease [1-3].

Angioplasty, using mechanical lumen enlargement with balloon or stents lead to internal elastic lamina fracture and medial dissection. Subsequently, many processes contribute to restenosis of the affected vessel [4]. Early elastic recoil and late reorganization of thrombus, cell proliferation and migration contribute in the pathogenic processes called in-stent stenosis. Thus, a negative remodelling is a major cause of human angioplasty restenosis [4,5]. Besides well-established biochemical pathways (e.g., drug-coated devices), covered stents may provide a mechanical approach to avoid restenosis.

Iliac artery atherosclerotic disease may cause intermittent claudication and chronic limb-threatening ischemia. It can further lead to complications such as infection, amputation and even death. Endovascular repair has become the first choice of treatment for iliac arterial occlusive disease [6]. However, no definitive consensus has reached about the best endovascular strategy and which type of stent, if any, to use. In more advanced disease, involving Transatlantic Inter-Society Consensus (TASC) C and D, long or multiple stenosis or occlusions, literature is most supportive of primary stenting with a balloon-expandable stent in the common iliac artery [7]. However, only one randomized controlled trial has been published on this stent in the common iliac artery [8]. Although no clear evidence exists that covered stents are associated with better patency rates in aorto-iliac occlusions, several studies found a difference in TASC C and D lesions in favour of covered stents [9].

Especially in the last two decades, endovascular repair has become the first choice of treatment for iliac atherosclerotic disease, after endovascular revolution. Historically, open surgical repair, was the standard way to treat iliac occlusions. There are no doubt that all those publications showed that both, covered and bare-metal stents can be used with good results for occlusive disease [5-8]. Although covered stents have broadly been associated with favourable results especially in restenosis, repeated interventions, and in complex lesions [5,7-9], there are also contradictory publications [10]. Available publications did neither include calcification or calcium analyses in the iliac arteries, nor did they show how the stratification between covered or uncovered stents was realized, nor subgroup analyses (e.g., size of the lesions, localizations, common or external iliac artery, occlusion versus stenosis). High-quality evidence supporting the use of covered stents for aorto-iliac occlusive arterial disease remains limited. More research is needed to identify specifically which lesion characteristics might benefit most from covered stent placement. While evidence from high quality randomized controlled trials is still lacking, international registry collaborations such as the VASCUNET or the International Consortium of Vascular Registries (ICVR) may provide real-world-evidence data to close the gap of knowledge [11].

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