14 - Target Lesion Revascularization in Patients with Infrapopliteal Long Segment Lesions Treated with Overlapping EES Stents
J. Watchmaker, R. Lookstein
Purpose: Evaluate clinical outcomes in patients with critical limb ischemia and long-segment (>38mm) infrapopliteal lesions treated with everolimus-eluting coronary stents (EES) with prior failed angioplasty (PTA).
Material and Methods: We reviewed outcomes in patients with long-segment lesions treated with EES after failed PTA between 01/2009 – 09/2018. The primary endpoint was a composite of freedom from death from any cause through 30-days, and freedom from target limb major amputation and CD-TLR through 12-months analyzed via the Kaplan-Meir method. Log-rank test was used to compare differences between Rutherford groups (Rutherford 4 and 5 compared to Rutherford 6).
Results: Sixty-three patients (age 73.6±11.2, 4 female 53 male), with sixty-five treated limbs met inclusion criteria. Thirty-seven Rutherford 4 or 5 limbs were included, and 28 Rutherford 6 limbs were included. Mean lesion length was 103.1±52.6mm [44.0-380mm]. The mean number of stents used was 2.8; range [2-10 stents] with a mean stent diameter of 3.4mm; range [2.5-4.0mm]. There were 11 deaths, 8 major amputations, and 7 CD-TLRs. Freedom from the composite endpoint was 70.6% for all patients. Rutherford 4 and 5 had a 84.6% freedom compared to Rutherford 6 with a 52.5% freedom from composite endpoint (HR 4.0, 95% CI 1.5-10.6, p=0.0059).
Conclusions: In patients with CLI, placement of multiple EES in long-segment infrapopliteal lesions with prior failed PTA is a durable treatment option, with Rutherford 4 and 5 patients demonstrating markedly better outcomes as measured by freedom from death from any cause through 30-days, and freedom from target limb amputation and CD-TLR through 12 months compared to Rutherford 6 patients.