Feasibility of Coronary Balloon-Expandable Drug-Eluting Stent Implantation for Focal Superficial Femoral Artery Disease

Abstract

AIM: Despite important advances in techniques and devices, endovascular treatment of the superficial femoral artery (SFA) is still fraught with suboptimal early and long-term adverse events. Coronary drug-eluting stents (DES) are associated with favorable results in patients with ischemic heart disease. Under the hypothesis that coronary DES may be safe and effective also for focal SFA lesions, we have used them in selected patients in the last few years. We thus aimed to review our experience with this novel treatment approach. METHODS: Patients undergoing coronary DES implantation in the SFA at our institutions were retrospectively identified. Baseline, procedural and outcome details were systematically collected. Outcomes of interest were duplex ultrasound-based primary patency, target lesion revascularization, target limb revascularization, and improvement in Fontaine class at the longest follow-up available. RESULTS: A total of 51 patients (54 limbs) were treated with coronary DES for SFA disease. Specifically, 23 (42.6%) limbs were treated with biolimus-eluting stents, 8 (14.8%) with everolimus-eluting stents, and 25 (46.3%) with sirolimus-eluting stents. All lesions were TASC A, with 24 (44.4%) total occlusions. Technical and procedural success was achieved in all cases. Clinical and duplex ultrasound-based follow-up, after a mean of 15.4±18.4 months, showed primary patency in 95.6% (95% confidence interval 85.2%-99.6%), target lesion revascularization in 3.8% (0.3%-13.3%), target limb revascularization in 5.8% (1.3%-15.7%), and improvement in Fontaine class in 84.9% (74.0%-93.5%). No case of stent thrombosis, fracture or crush occurred. CONCLUSION: Use of coronary DES for focal SFA lesions is feasible and safe, and associated with favorable clinical results at mid-term follow-up. Further controlled studies are warranted to define more precisely the risk-benefit ratio of these devices in comparison to SFA-dedicated DES and drug-eluting balloons.