Paclitaxel-Eluting Stents Show Superiority to Balloon Angioplasty and Bare Metal Stents in Femoropopliteal Disease

TLDR

Sustained benefits of drug‑eluting stents in femoropopliteal arteries have not been demonstrated. The study prospectively compared 12‑month safety and effectiveness of a polymer‑free paclitaxel‑coated nitinol drug‑eluting stent with percutaneous transluminal angioplasty and provisional bare metal stent in patients with femoropopliteal peripheral artery disease. Patients were randomized to primary drug‑eluting stent or angioplasty, and those with acute angioplasty failure were re‑randomized to provisional drug‑eluting stent or bare metal stent, with primary endpoints defined as 12‑month event‑free survival and patency. The drug‑eluting stent achieved superior 12‑month event‑free survival (90.4% vs 82.6%) and primary patency (83.1% vs 32.8%) versus angioplasty, and also outperformed provisional bare metal stent in patency and clinical benefit, with a low stent fracture rate of 0.9%.

Abstract

Sustained benefits of drug-eluting stents in femoropopliteal arteries have not been demonstrated. This prospective, multinational, randomized study was designed to compare the 12-month safety and effectiveness of a polymer-free, paclitaxel-coated nitinol drug-eluting stent (DES) with percutaneous transluminal angioplasty (PTA) and provisional bare metal stent (BMS) placement in patients with femoropopliteal peripheral artery disease.Patients were randomly assigned to primary DES implantation (n=236) or PTA (n=238). Demographics and lesion characteristics were similar between groups (eg, average lesion length, approximately 65±40 mm). One hundred twenty patients had acute PTA failure and underwent secondary random assignment to provisional DES (n=61) or BMS (n=59). Primary end points were the 12-month rates of event-free survival and patency in the primary DES and PTA groups. Compared with the PTA group, the primary DES group exhibited superior 12-month event-free survival (90.4% versus 82.6%; P=0.004) and primary patency (83.1% versus 32.8%; P<0.001), satisfying the primary hypotheses. In the secondary evaluations, (1) the primary DES group exhibited superior clinical benefit compared with the PTA group (88.3% versus 75.8%; P<0.001), (2) the provisional DES group exhibited superior primary patency (89.9% versus 73.0%; P=0.01) and superior clinical benefit (90.5% and 72.3%, P=0.009) compared with the provisional BMS group, and (3) the stent fracture rate (both DES and BMS) was 0.9% (4/457).Femoropopliteal peripheral artery disease treatment with the paclitaxel-eluting stent was associated with superior 12-month outcomes compared with PTA and provisional BMS placement.