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Stentgestützte Rekanalisation der femoropoplitealen arteriellen Verschlusskrankheit

Einfluss des Stentdesigns auf die Offenheitsrate

Stent-assisted recanalization of femoropopliteal arterial occlusive disease

Influence of stent design on patency rates

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Zusammenfassung

Hintergrund

Die Ergebnisse der endovaskulären Behandlung der femoropoplitealen Strombahn bleiben trotz enormer technischer Fortschritte noch hinter den Erwartungen zurück. Die Rolle des Stentings wird dabei immer noch kontrovers diskutiert. Unklar ist, inwiefern neuere Stentdesigns Vorteile bzgl. der Offenheitsraten bieten.

Ziel der Arbeit

Vergleich der verfügbaren Daten zu Offenheitsraten und Reinterventionsraten nach Einsatz verschiedener Stentdesigns in der femoropoplitealen Strombahn.

Material und Methoden

Analyse von insgesamt 25 publizierten Studien aus den Jahren 2006 bis 2015 zu klassischen Open-cell-Stents, gewobenen Stents, teil- und vollgecoverten Stents.

Ergebnisse und Diskussion

Die Datenlage ist sehr uneinheitlich und direkte Vergleichsstudien zu verschiedenen Stentdesigns fehlen vollständig. Über die Jahre konnten die Offenheitsraten nach femoropoplitealem Stenting verbessert werden. Für kurzstreckige Läsionen < 5 cm bietet sich nach Studienlage jedoch kein Vorteil für Stents gegenüber der Ballonangioplastie. Primäres Stenting wird mittlerweile bei Läsionen > 6,4 cm empfohlen. Klare Unterschiede in den Offenheitsraten lassen sich für die verschiedenen Stentdesigns aufgrund der uneinheitlichen Datenlage nicht ausmachen, die Ergebnisse für gewobene Stents zeigen aber zumindest tendenziell eine Verbesserung. Randomisierte Vergleichsstudien sind nötig, um dieses Ergebnis zu bestätigen.

Abstract

Background

Despite enormous technical progress the results of endovascular treatment of the femoropopliteal vasculature are unsatisfactory and its role is still controversially discussed. In the past decade numerous new stent designs have come onto the market but it is unclear whether they have benefits with respect to patency rates.

Objectives

Comparison of published data on patency rates and target lesion revascularization rates after use of different stent designs in the femoropopliteal vasculature.

Material and methods

Analysis of 25 published studies and registries from 2006 to 2015 for classical open-cell stents, interwoven stents and partially or fully covered stents.

Results and conclusion

The published data are heterogeneous and comparative studies for different stent designs are completely missing. Over the past decade the patency rates after femoropopliteal stenting could be improved. According to available data stenting of short lesions < 5 cm does not show any benefit compared to isolated balloon angioplasty. Primary stenting is now recommended for intermediate and longer lesions > 6.4 cm. Due to the heterogeneity of published data a clear benefit for a specific stent design is not obvious; however, data for interwoven stents are promising and show a tendency towards improved patency, at least for certain lesions. Randomized controlled comparative trials are needed to confirm this result.

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M. Treitl weist auf folgende Beziehung hin: Er ist Consultant für Meditronic und Abbot. M.F. Reiser und K.M. Treitl geben an, dass kein Interessenkonflikt besteht.

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Treitl, M., Reiser, M.F. & Treitl, K.M. Stentgestützte Rekanalisation der femoropoplitealen arteriellen Verschlusskrankheit. Radiologe 56, 233–239 (2016). https://doi.org/10.1007/s00117-016-0077-y

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