Randomized Trial of the SMART Stent versus Balloon Angioplasty in Long Superficial Femoral Artery Lesions: The SUPER Study

Abstract

Purpose

To determine whether primary stenting reduces the rate of restenosis compared with balloon angioplasty alone in the endovascular treatment of long superficial femoral artery lesions; and to assess the effect of treatment on quality of life.

Methods

A total of 150 patients with superior femoral artery occlusion or severe stenosis of 5–22 cm length from 17 UK centers were randomized to either primary stenting with the SMART stent or balloon angioplasty (i.e., percutaneous transluminal angioplasty, PTA). Bailout stent placement was permitted in case of inadequate result from PTA. The primary end point was restenosis measured by duplex ultrasound at 1 year. Quality-of-life assessments were performed by the EuroQol (EQ)-5D questionnaire.

Results

Mean lesion length was 123.0 mm in the stent group and 116.8 mm in the PTA group. A total of 140 (93.3 %) of 150 had total occlusions. At 12 months’ follow-up, restenosis measured by Duplex ultrasound was not significantly different between the stent and PTA groups by intention-to-treat or as-treated analyses: 47.2 versus 43.5 % (p = 0.84) and 40.8 versus 46.7 % (p = 0.68), respectively. There were fewer target lesion revascularizations in patients randomized to stenting, but this did not reach statistical significance (12.5 vs. 20.8 %, p = 0.26). There was no difference in the rate of amputation. Patients in both groups reported improved quality of life.

Conclusion

Primary stenting of long lesions in predominantly occluded superficial femoral arteries does not reduce the rate of binary restenosis compared with balloon angioplasty and bailout stenting. Both treatment strategies conferred a meaningful and sustained improvement to the quality of life of patients with severe superficial femoral artery disease.

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Acknowledgments

The SUPER study was sponsored and funded by Cordis Clinical Research.

Conflict of interest

SF and MvR are paid employees of Cordis, Johnson & Johnson. The other authors declare that they have no conflict of interest.

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Corresponding author

Correspondence to Nicholas Chalmers.

Additional information

This study was conducted on behalf of the SUPER study investigators.

List of lead investigators, study site and number of patients recruited.

Appendix: The SUPER study investigators

Appendix: The SUPER study investigators

The Investigators of the above study was conducted on behalf of The SUPER study: N. Chalmers, Manchester Royal Infirmary (n = 33 patients recruited); P. Walker, James Cook University Hospital, Middlesbrough (18); A. Belli, St. George’s Hospital, London (14); A. Thorpe, Aberdeen Royal Infirmary (14); P. Sidhu, King’s College Hospital, London (12); G. Robinson, Hull Royal Infirmary (11); T. Cleveland, Northern General Hospital, Sheffield (9); K. Gill, Pinderfields Hospital, Wakefield (9), R. Ashleigh, Wythenshawe Hospital, Manchester (6); M. Matson, Royal London Hospital (5); J. Cockburn, Norfolk and Norwich University Hospital, Norwich (4); A. Collins, Royal Victoria Hospital, Belfast (4); G. Houston, Ninewells Hospital, Dundee (3); J. Patel, St. James’ Hospital, Leeds (3); M. Cowling, City General Hospital, Stoke-on-Trent (2); J. Moss, Gartnavel Hospital, Glasgow (2); S. Travis, Royal Cornwall Hospital, Truro (1).

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Chalmers, N., Walker, P.T., Belli, A. et al. Randomized Trial of the SMART Stent versus Balloon Angioplasty in Long Superficial Femoral Artery Lesions: The SUPER Study. Cardiovasc Intervent Radiol 36, 353–361 (2013). https://doi.org/10.1007/s00270-012-0492-z

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Keywords

  • Balloon angioplasty
  • Long lesions
  • Randomized trial
  • SMART stent
  • Superficial femoral artery