133 - Review of The Utility of Drug-Eluting Stents in Peripheral Arterial Disease by Different Vascular Beds
Austin Shinagawa, MD – Resident, Kaiser Permanente; Geogy Vatakencherry, MD – Attending, Kaiser Permanente
Purpose: Randomized controlled trial (RCT) data in recent years have shown potential in the application of drug-eluting stents (DES) that were standardly used for coronary artery disease now for the treatment of peripheral arterial disease (PAD). However, there are few reviews of the utility of DES organized by vascular bed. Herein, we conduct an up-to-date review of recent literature on the applications of DES in the treatment of PAD and provide recommendations for further investigations.
Material and Methods: A PubMed search was conducted using relevant search terms to identify RCTs that compared DES to other peripheral arterial interventions. 12 RCTs were identified and classified based on the vascular bed of interest: femoropopliteal, infrapopliteal, renal, extracranial, or intracranial. Case reports and retrospective studies were also identified by vascular beds. Data from the trials was organized using a table that compared primary/secondary endpoints, comorbidities, lesion length, vessel diameter, and length of follow-up period.
Results: RCTs for DES use in femoropopliteal disease that met the inclusion criteria were SIROCCO I & II, RESILIENT, ZILVER PTX, and IMPERIAL. Infrapopliteal studies included DESTINY, ACHILLES, IDEAS, PADI, YUKON-BTK, and SAVAL. The primary endpoint of these trials was vessel patency at the time of follow-up, and patients in the DES arm showed greater target vessel patency than patients in the control arm. The GREAT trial and Li et al. (2009) both demonstrated a reduced restenosis and target vessel revascularization rate in DES use for renal artery stenosis as compared to control.
Conclusions: DES are demonstrated to be a safe and effective treatment option for patients with PAD of the femoropopliteal or infrapopliteal regions as compared to bare metal stents (BMS), percutaneous transluminal angioplasty (PTA) and drug-coated balloons (DCB). Although there have been many studies comparing DES to BMS, PTA, or DCB, there are few head-to-head comparisons of DES, which would provide utility in determining the optimal properties of DES. Additionally, studies on the use of DES for renal, supra-aortic, intra- and extracranial arterial disease are sparse, and further investigations are recommended for determining the safety and efficacy of DES in these vascular beds.