Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202000142
Jornal Vascular Brasileiro
Original Article

Stent fractures in the superficial femoral artery: predisposing factors and their implications

Fraturas de stents na artéria femoral superficial: fatores predisponentes e suas implicações

Fernando Trés Silveira; Álvaro Razuk Filho; Paulo Fernandes Saad; Karen Ruggeri Saad; Gustavo José Politzer Telles; Pedro Ivo C. Ravizzini; Roberto Augusto Caffaro; Valter Castelli Júnior

Downloads: 2
Views: 938

Abstract

Abstract: Background: Fractures in stents implanted in the superficial femoral artery (SFA) are recognized complications of endovascular management of this arterial territory.

Objectives: The objective of this study was to determine the prevalence of fractures in stents implanted in the SFA and to identify predisposing factors for these fractures together with their impact on the patency of these devices.

Methods: The study included 39 patients (65.7±9.0 years) who previously underwent angioplasty for delivery of 56 stents into the SFA. During follow-up, which ranged from 7 to 46 months, variables were collected on the characteristics of the lesions treated and characteristics of the stents implanted. Two examiners independently analyzed digital radiographs for the presence of stent fractures and the patency of the devices.

Results: We found a 10.7% prevalence of fracture of implanted stents. Implantation of multiple stents was identified as a significant predisposing factor for fractures. We observed a marked tendency for fractures in female patients and in lesions treated with longer stents (> 150 mm). Stenosis exceeding 50% and occlusions were significantly more frequent in fractured stents.

Conclusions: This study suggests that implants longer than 150 mm and multiple stents are associated with higher device fracture rates. In cases with stent fractures, stenoses exceeding 50% and occlusions were significantly more frequent.

Keywords

peripheral arterial disease, stents, endovascular procedures

Resumo

Resumo: Contexto: As fraturas de stents implantados na artéria femoral superficial (AFS) são uma complicação reconhecida pós-tratamento endovascular desse território arterial.

Objetivos: Este estudo objetivou determinar a presença de fraturas nos stents implantados na AFS e identificar fatores predisponentes para essas fraturas, juntamente com o impacto na perviedade desses dispositivos.

Métodos: Foram incluídos 39 pacientes (65,7±9,0 anos) previamente submetidos à angioplastia para colocação de 56 stents na AFS. Durante o seguimento, que variou de 7 a 46 meses, foram coletadas variáveis referentes às características das lesões tratadas e às características dos stents implantados. Dois examinadores analisaram radiografias digitais para verificar a presença de fraturas de stent e a perviedade dos dispositivos independentemente.

Resultados: Foi encontrada uma prevalência de 10,7% de fratura nos stents implantados. O implante de múltiplos stents foi identificado como fator predisponente significativo para fraturas. Foi observada uma tendência acentuada de fraturas em pacientes do sexo feminino e em lesões tratadas com stents mais longos (> 150 mm). As estenoses acima de 50% e as oclusões foram significativamente mais frequentes em stents fraturados.

Conclusões: Este estudo sugere que implantes de múltiplos stents ou de stents com extensão maior que 150 mm estão associados a maiores taxas de fraturas do dispositivo. No caso de fraturas de stents, as estenoses mais significativas que 50% e as oclusões foram consideravelmente mais frequentes.
 

Palavras-chave

doença arterial periférica, stents, procedimentos endovasculares

References

1 Adlakha S, Sheikh M, Wu J, et al. Stent fracture in the coronary and peripheral arteries. J Interv Cardiol. 2010;23(4):411-9. http://dx.doi.org/10.1111/j.1540-8183.2010.00567.x. PMid:20806458.

2 Ferreira M, Capotorto LF, Abuhadba G, Monteiro M, Lanziotti L. Recanalização da artéria femoral superficial com stents Zilver: técnica padronizada e análise retrospectiva de 3 anos. J Vasc Bras. 2006;5(4):263-70. http://dx.doi.org/10.1590/S1677-54492006000400005.

3 Laird J. Interventional options in the SFA. Endovasc Today. 2004;(Suppl.):9-12.

4 Duda SH, Pusich B, Richter G, et al. Sirolimus-eluting stents for the treatment of obstructive superficial femoral artery disease: six-month results. Circulation. 2002;106(12):1505-9. http://dx.doi.org/10.1161/01.CIR.0000029746.10018.36. PMid:12234956.

5 Duda SH, Bosiers M, Lammer J, et al. Drug-eluting and bare nitinol stents for the treatment of atherosclerotic lesions in the superficial femoral artery: long-term results from de SIROCCO trial. J Endovasc Ther. 2006;13(6):701-10. http://dx.doi.org/10.1583/05-1704.1. PMid:17154704.

6 Canan T, Lee MS. Drug-eluting stent fracture: incidence, contributing factors, and clinical implications. Catheter Cardiovasc Interv. 2010;75(2):237-45. http://dx.doi.org/10.1002/ccd.22212. PMid:20025045.

7 Andrassy M, Celik S, Andrassy J, Lichtenberg MK, Brodmann M. The role of drug-coated balloons in in-stent restenosis. J Cardiovasc Surg. 2017;58(4):501-7. http://dx.doi.org/10.23736/S0021-9509.17.09963-3. PMid:28358184.

8 Deloose K, Callaert J. Less is more: the “As Less As Reasonably Achievable Stenting” (ALARAS) strategy in the femoropopliteal area. J Cardiovasc Surg. 2018;59(4):495-503. http://dx.doi.org/10.23736/S0021-9509.18.10583-0. PMid:29790719.

9 Duda SH, Bosiers M, Lammer J, et al. Sirolimus-eluting versus bare nitinol stent for obstructive superficial femoral artery disease: the SIROCCO II trial. J Vasc Interv Radiol. 2005;16(3):331-8. http://dx.doi.org/10.1097/01.RVI.0000151260.74519.CA. PMid:15758128.

10 Sabeti S, Schillinger M, Amighi J, et al. Primary patency of femoroplopliteal arteries treated with nitinol versus stainless steel self-expanding stents: propensity score-adjusted analysis. Radiology. 2004;232(2):516-21. http://dx.doi.org/10.1148/radiol.2322031345. PMid:15286322.

11 Sabeti S, Mlekusch W, Amighi J, Minar E, Schillinger M. Primary patency of long-segment self-expanding nitinol stents in the femoropopliteal arteries. J Endovasc Ther. 2005;12(1):6-12. http://dx.doi.org/10.1583/04-1359.1. PMid:15683273.

12 Allie DE, Hebert CJ, Ricis RT, Walker CGM. Nitinol stent fractures in the SFA. Endovasc. Today. 2004;7:22-34.

13 Iida O, Nanto S, Uematsu M, et al. Effects of exercise on frequency of stent fracture in the superficial femoral artery. Am J Cardiol. 2006;98(2):272-4. http://dx.doi.org/10.1016/j.amjcard.2006.01.091. PMid:16828607.

14 Gouëffic Y, Kaladji A. Commentary: the clinical relevance of superficial femoral artery stent fractures remains obscure. J Endovasc Ther. 2015;22(3):327-9. http://dx.doi.org/10.1177/1526602815583662. PMid:25904487.

15 Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(1, Suppl. S):S5-67. http://dx.doi.org/10.1016/j.jvs.2006.12.037. PMid:17223489.

16 Schlager O, Dick P, Sabeti S, et al. Long-segment SFA stenting–The dark sides: In-stent restenoses, clinical deterioration, and stent fractures. J Endovasc Ther. 2005;12(6):676-84. http://dx.doi.org/10.1583/05-1672.1. PMid:16363897.

17 Iida O, Nanto S, Uematsu M, Ikeoka K, Okamoto S, Nagata S. Influence of stent fracture on the long-term patency in the femoro-popliteal artery. JACC Cardiovasc Interv. 2009;2(7):665-71. http://dx.doi.org/10.1016/j.jcin.2009.04.014. PMid:19628191.

18 Soga Y, Iida O, Hirano K, Yokoi H, Nanto S, Nobuyoshi M. Mid-term clinical outcome and predictors of vessel patency after femoropopliteal stenting with self-expansible nitinol stent. J Vasc Surg. 2010;52(3):608-15. http://dx.doi.org/10.1016/j.jvs.2010.03.050. PMid:20573476.

19 Iida O, Soga Y, Hirano K, et al. Retrospective multicentre analysis of S.M.A.R.T vs. Luminexx nitinol stent implantation for superficial femoral artery lesions (REAL SL) Registry: 5 years’ experience. Circ J. 2011;75(2):421-7. http://dx.doi.org/10.1253/circj.CJ-10-0741. PMid:21224520.

20 Schillinger M, Sabeti S, Loewe C, et al. Balloon angioplasty vs. implantation of nitinol stents in the superficial femoral artery. N Engl J Med. 2006;354(18):1879-88. http://dx.doi.org/10.1056/NEJMoa051303. PMid:16672699.

21 Scheinert D, Scheinert S, Sax J, et al. Prevalence and clinical impact of stent fractures after femoropopliteal stenting. J Am Coll Cardiol. 2005;45(2):312-5. http://dx.doi.org/10.1016/j.jacc.2004.11.026. PMid:15653033.

22 Klein AJ, Chen SJ, Messenger JC, et al. Quantitative assessment of conformational change in the femoropopliteal artery with leg movement. Catheter Cardiovasc Interv. 2009;74(5):787-98. http://dx.doi.org/10.1002/ccd.22124. PMid:19521998.

23 Ganguly A, Simons J, Schneider A, Keck B, Bennett NR, Fahrig R. In-vitro imaging of femoral artery nitinol stents for deformation analysis. J Vasc Interv Radiol. 2011;22(2):236-43. http://dx.doi.org/10.1016/j.jvir.2010.10.017. PMid:21276916.

24 Pelton AR, Schroeder V, Mitchell MR, Gong XY, Barney M, Robertson SW. Fatigue and durability of nitinol stents. J Mech Behav Biomed Mater. 2008;1(2):153-64. http://dx.doi.org/10.1016/j.jmbbm.2007.08.001. PMid:19627780.

25 Alzamora MT, Forés R, Baena-Diez JM, et al. The peripheral arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population. BMC Public Health. 2010;10(1):38. http://dx.doi.org/10.1186/1471-2458-10-38. PMid:20529387.

26 Soga Y, Iida O, Hirano K, Suzuki K, Yokoi H, Nobuyoshi M. Restenosis after stent implantation for superficial femoral artery disease in patients treated with cilostazol. Catheter Cardiovasc Interv. 2012;79(4):541-8. http://dx.doi.org/10.1002/ccd.23304. PMid:21805619.
 


Submitted date:
03/03/2020

Accepted date:
09/23/2020

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
632470c0a953955e277f2032 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections