Drug-Eluting Stents Show Promise in Peripheral Artery Disease

A new study demonstrates superior short-term results with drug eluting stents (DES) compared with bare metal stents (BMS) in the treatment of infrapopliteal peripheral arterial disease (PAD).

Researchers at the Manchester Royal Infirmary (United Kingdom) and Philipps University Marburg (Germany) conducted a systematic review of literature to identify all studies comparing stent treatments of infragenicular vessels in patients with chronic lower limb ischemia (CLI). The search identified four randomized clinical trials and two observational studies reporting on 544 patients (287 treated with DES and 257 treated with BMS). The outcome data were pooled, and combined overall effect sizes were presented as the odds ratio (OR) and the number-needed-to-treat (NNT).

The results showed that primary patency, freedom from target lesion revascularization (TLR), and clinical improvement at one year were significantly higher in the DES recipients compared to patients treated with BMS. No significant differences in limb salvage and overall survival at one year were identified between the groups. Sensitivity analyses investigating the potential effects of study design and type of DES on the combined outcome estimates validated the results. The study was published in the April 2013 issue of the Journal of Endovascular Therapy.

“Emerging evidence exists supporting the safety and efficacy of DES in the treatment of infrapopliteal artery disease. This analysis has demonstrated favorable one year results with DES as compared with BMS, expressed by increased patency rates and freedom from TLR,” concluded lead author George Antoniou , MD, PhD, of the department of vascular and endovascular surgery, and colleagues. “It remains to be determined whether or not improvement in such outcome measures will be reflected in clinical parameters, such as limb salvage and wound healing.”

PAD results when the peripheral arteries become too narrow or obstructed due to plaque,limiting the blood flow to the legs. If left untreated, PAD can cause pain or aching in the legs, difficulty with walking, resting pain in the foot at night in bed, non-healing sores or infections in the toes or feet, and can ultimately lead to limb loss in its most severe form. In addition, it can be associated with other serious arterial conditions leading to heart attacks and stroke.

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Manchester Royal Infirmary
Philipps University Marburg