1. Giuseppe Biondi Zoccai
Drug-eluting or absorbable stents versus bare-metal stents in peripheral artery disease
Giuseppe Biondi Zoccai
Divisione di Cardiologia, Università di Torino

2. Biondi Zoccai et al, G Ital Cardiol 2009
Scope of the problem
Biondi Zoccai et al, G Ital Cardiol 2009

3. Scope of the problem - II

4. Scope of the problem - III

5. TASC II 2007 vs. TASC 2000

6. Why stents? Balloon-only angioplasty is fraught with:
Elastic recoil
Flow-limiting dissection
Constrictive remodeling
Neointimal hyperplasia
Biocompatibility
Stents may address these issues

7. Why stents? Balloon-only angioplasty is fraught with:
Elastic recoil
Flow-limiting dissection
Constrictive remodeling
Neointimal hyperplasia
Biocompatibility
Stents may address these issues
BMS

8. Why stents? Balloon-only angioplasty is fraught with:
Elastic recoil
Flow-limiting dissection
Constrictive remodeling
Neointimal hyperplasia
Biocompatibility
Stents may address these issues
DES

9. Why stents? Balloon-only angioplasty is fraught with:
Elastic recoil
Flow-limiting dissection
Constrictive remodeling
Neointimal hyperplasia
Biocompatibility
Stents may address these issues
ABS

10. Explosion of data on stents for PAD
PubMed queried on 7 December 2009: stent* AND (femoral OR popliteal OR femoropopliteal OR "femoro-popliteal" OR tibial OR "infra-popliteal" OR infrapopliteal OR (critical AND limb AND ischemia)) NOT (vein OR venous)

11. Iliac stenting: just in bail-out?
Dutch Iliac Stent Trial: randomized trial of stenting vs balloon-only PTA (with stent if complications or mean gradient >10 mm Hg)*
*stenting finally performed in 40% of pts randomized to PTA
Routine stenting
PTA with
selective stenting
Klein et al, Radiology 2006

12. The FAST trial: Luminexx stent

13. The ABSOLUTE trial: Absolute stent
Schillinger et al, Circulation 2007

14. The RESILIENT II trial: LifeStent 12-month results

15. Can you beat new bare-metal stents?

16. The SIROCCO I trial: Sirolimus-eluting Smart stent
Duda et al, Circulation 2002

17. Duda et al, J Vasc Interv Radiol 2005
The SIROCCO II trial: Sirolimus-eluting Smart stent Freedom from restenosis
71.8%
67.2%
Duda et al, J Vasc Interv Radiol 2005

18. Zilver paclitaxel eluting stent

19. Repeat PTA after BTK stenting
Biondi-Zoccai et al, J Endovasc Ther 2009

20. What about absorbable stents?
BASELINE
POST-AMS
6 MONTHS
Bosiers et al, Cardiovasc Intervent Radiol 2009

21. What about absorbable stents?
6-month angiographic patency rate:
31.8% for AMS vs. 58.0% for PTA (p=0.013)
Bosiers et al, Cardiovasc Intervent Radiol 2009

22. Take home messages
Primary stenting with self-expandable bare-metal stents is considered by many the standard of care for iliac and superficial femoral arteries
Bail-out drug-eluting stenting is beneficial for infra-popliteal lesions
Conversely, stents (any) should be avoided in common femoral or popliteal arteries
Further clinical evidence is needed before deciding on the role of absorbable stents and femoral drug-eluting stents

23. Thank you for your attention For any correspondence: For these and further slides on these topics feel free to visit the metcardio.org website: