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Adobe Flash Player is required to view this feature. If you are using an operating system that does not support Flash, we are working to bring you alternative formats. Original Article Balloon Angioplasty versus Implantation of Nitinol Stents in the Superficial Femoral Artery Martin Schillinger, M.D., Schila Sabeti, M.D., Christian Loewe, M.D., Petra Dick, M.D., Jasmin Amighi, M.D., Wolfgang Mlekusch, M.D., Oliver Schlager, M.D., Manfred Cejna, M.D., Johannes Lammer, M.D., and Erich Minar, M.D. N Engl J Med 2006; 354:1879-1888 DOI: 10.1056/NEJMoa051303.

Background Because stent implantation for disease of the superficial femoral artery has been associated with high rates of late clinical failure, percutaneous transluminal angioplasty is preferred for endovascular treatment, and stenting is recommended only in the event of suboptimal technical results. We evaluated whether primary implantation of a self-expanding nitinol (nickel–titanium) stent yielded anatomical and clinical benefits superior to those afforded by percutaneous transluminal angioplasty with optional secondary stenting. Results The mean (±SD) length of the treated segment was 132±71 mm in the stent group and 127±55 mm in the angioplasty group. Secondary stenting was performed in 17 of 53 patients (32 percent) in the angioplasty group, in most cases because of a suboptimal result after angioplasty.

At 6 months, the rate of restenosis on angiography was 24 percent in the stent group and 43 percent in the angioplasty group (P=0.05); at 12 months the rates on duplex ultrasonography were 37 percent and 63 percent, respectively (P=0.01). Patients in the stent group were able to walk significantly farther on a treadmill at 6 and 12 months than those in the angioplasty group. Figure 1 Rates of Restenosis on Angiography (Panel A) and Duplex Ultrasonography (Panel B).

Search the world's information, including webpages, images, videos and more. Google has many special features to help you find exactly what you're looking for. Of superficial-femoral-artery disease by primary implantation of a self-expanding nitinol stent yielded results that were superior to those with the currently recommended approach of balloon angioplasty with optional secondary stenting. (ClinicalTrials.gov number, NCT00281060.) Full Text of Discussion. Point Facture Serial Cracks. 3/21/2017 0 Comments Maghribiyat rap amazigh Chel. JAIT ideal starting point traveller Africa voyageur Cvsy Pqs.

Restenosis was defined as stenosis of more than 50 percent. Panel A shows the rates as determined by angiography at six months, analyzed according to the intention-to-treat principle and according to the treatment actually received. Panel B shows the rates of restenosis in the same patients as determined by duplex ultrasonography at 3, 6, and 12 months, analyzed according to the intention-to-treat principle. I bars indicate 95 percent confidence intervals. The use of percutaneous transluminal angioplasty to revascularize the superficial femoral artery can result in initial technical success rates of more than 95 percent, with a low risk of complications. However, late clinical failure remains an important concern. Restenosis occurs in 40 to 60 percent of treated segments after one year.

The use of angioplasty to treat extensive disease of the superficial femoral artery has particularly poor results: at one year, the rates of restenosis exceed 70 percent for lesions longer than 100 mm. Endovascular stenting avoids the problems of early elastic recoil, residual stenosis, and flow-limiting dissection after balloon angioplasty and can thus be used for the treatment of long and complex lesions, even in heavily calcified arteries.

Initial studies of stenting of the superficial femoral artery reported promising results, with patency rates of more than 85 percent at 18 months. However, subsequent studies found that exaggerated neointimal hyperplasia frequently leads to in-stent restenosis, and five randomized, controlled trials failed to demonstrate any benefit of a stainless-steel stent over angioplasty alone. Therefore, stenting of the superficial femoral artery is currently recommended only as a bailout procedure after technical failure of angioplasty. The use of nitinol stents has been reported to improve the durability of stenting of the superficial femoral artery, with a restenosis rate of only 7.7 percent at six months.