Stents in der Arteria femoralis: Hilfe oder Problem?

Zusammenfassung

Die perkutane transluminale Angioplastie (PTA) ist eine gut etablierte Technik bei der Behandlung symptomatischer Stenosen und Okklusionen in der femoropoplitealen Strombahn. Sie ist eine Behandlungsmethode mit ausgezeichneten initialen technischen und klinischen Ergebnissen. Die Langzeitresultate der alleinigen PTA müssen jedoch als unbefriedigend bezeichnet werden, da Rezidive häufig sind. In der Vergangenheit schien die femoropopliteale Stentimplantation ein vielversprechendes Mittel zu sein, um Rezidive zu verhindern und die Offenheitsrate zu steigern. Dennoch vermochte sie keine besseren Ergebnisse im Vergleich zur alleinigen PTA hervorzubringen. Aus diesem Grunde sind alternative Strategien (z.B. Brachytherapie, medikamentenfreisetzende Pharmastents, Gentherapie) entwickelt worden. Mehrere Untersucher sind zurzeit dabei, ihren möglichen Nutzen zu erforschen. Diese Arbeit gibt einen Überblick über die Möglichkeiten der PTA und Stenttherapie in der femoropoplitealen Strombahn und betrachtet zukünftige Therapiekonzepte. Vor diesem Hintergrund wird die aktuelle klinische Literatur diskutiert.

Summary

Percutaneous transluminal angioplasty (PTA) is a wellestablished technique in the treatment of symptomatic femoropopliteal artery stenoses and obstructions. It is a method of treatment with excellent initial technical and clinical results. However, the long-term results of PTA alone must be considered as unsatisfactory as recurrences are frequently observed. In the past, femoropopliteal stenting appeared to be a promising tool to prevent recurrence and to increase patency rates, but it did not produce better results than PTA alone. For this reason, alternative therapeutic strategies such as brachytherapy, drug-eluting pharmastents and gene therapy were developed. Several investigators are beginning to explore their potential use. This article reviews the present possibilities of PTA and stenting in the femoropopliteal region and considers potential future concepts. In this context, the current clinical literature is discussed.

Schlüsselwörter

Femoralarterien - perkutane transluminale Angioplastie - Stents

Keywords

Femoral arteries - percutaneous transluminal angioplasty - stents

• Literatur

• 1 Amols HI, Zaider M, Weinberger J. et al. Dosimetric considerations for catheter-based beta and gamma emitters in the therapy of neointimal hyperplasia in human coronary arteries. Int J Radiat Oncol Biol Phys 1996; 36: 913-21.
• 2 Barth KH, Virmani R, Froehlich J. et al. Paired comparison of vascular wall reactions to Palmaz stents, Strecker tantalum stents, and Wallstents in canine iliac and femoral arteries. Circulation 1999; 93: 2161-9.
• 3 Becker GJ, Katzen BT, Dake MD. Noncoronary angioplasty. Radiology 1989; 170: 921-40.
• 4 Bergeron P, Pinot JJ, Poyen V. et al. Long-term results with the Palmaz stent in the superficial femoral artery. J Endovasc Surg 1995; 2: 161-7.
• 5 Bertrand M, McFadden EP, Fruchart JC. et al. Effect of pravastatin on angiographic restenosis after PTCA: the PREDICT trial investigators. J Am Coll Cardiol 1997; 30: 863-9.
• 6 Boettcher HD, Schopohl B, Liermann D. et al. Endovascular irradiation: a new method to avoid recurrent stenosis after stent implantation in peripheral arteries – technique and preliminary results. Int J Radiat Oncol Biol Phys 1994; 29: 183-6.
• 7 Capek P, McLean GK, Berkowitz HD. Femoropopliteal angioplasty: factors influencing long-term success. Circulation 1991; 83 (Suppl. 01) 70-80.
• 8 Carrie D, Khalife K, Hamon M. et al. Initial and follow-up results of the Tenax coronary stent. J Interv Cardiol 2001; 14: 1-5.
• 9 Castaneda-Zuniga WR, Formanek A, Tadavarthy M. et al. The machanism of balloon angioplasty. Radiology 1980; 135: 565-71.
• 10 Cejna M, Schoder M, Lammer J. PTA vs. stents in femoropopliteal obstruction. Radiologe 1999; 39: 144-50.
• 11 Cejna M, Thurnher S, Illiasch H. et al. Percutaneous transluminal angioplasty (PTA) versus Palmaz stent placement in femoropopliteal artery obstruction: a multicenter prospective randomized study. J Vasc Interv Radiol 2001; 12: 23-31.
• 12 Cragg AH, Dake MD. Percutaneous femoropopliteal graft placement. Radiology 1993; 187: 643-8.
• 13 Cragg AH, Dake MD. Treatment of peripheral vascular disease with stent-grafts. Radiology 1997; 205: 307-14.
• 14 Currie IC, Wakeley CJ, Cole SE. et al. Femoropopliteal angioplasty for severe limb ischemia. Br J Surg 1994; 81: 191-3.
• 15 Davies AH, Cole SE, Magee TR. et al. The effect of diabetes mellitus on the outcome of angioplasty for lower limb ischemia. Diabetic Medicine 1992; 9: 480-1.
• 16 Dichek DA, Neville RF, Zwiebel JA. et al. Seeding of intravascular stents with genetically engineered endothelial cells. Circulation 1989; 80: 1347-532.
• 17 Do DD, Triller J, Walpoth BH. et al. A comparison study of self-expandable stents vs balloon angioplasty alone in femoropopliteal artery occlusions. Cardiovasc Interv Radiol 1992; 15: 306-12.
• 18 Dotter CT, Judkins MP. Transluminal treatment of arteriosclerotic obstruction: description of a new technique and a preliminary report of its application. Circulation 1964; 30: 654-70.
• 19 Faxon DP. Effect of high dose angiotensin-converting enzyme inhibition on restenosis: final results of the MARCATOR Study, a multicenter, double-blind placebo-controlled trial of calizapril. The Multicenter American Research Trial With Cilazapril After Angioplasty To Prevent Transluminal Coronary Obstruction and Restenosis (MARCATOR) Study group. J Am Coll Cardiol 1995; 25: 362-9.
• 20 Fischell TA, Kharma BK, Fischell DR. Lowdose, beta-particle emission from stent wire results in complete, localized inhibition of smooth muscle cell proliferation. Circulation 1994; 90: 2956-63.
• 21 Fontaine AB, Spigos DG, Eaton G. et al. Stent-induced intimal hyperplasia: are there fundamental differences between flexible and rigid stent designs?. J Vasc Interv Radiol 1994; 5: 739-44.
• 22 Fox R. American Heart Association 2001 scientific sessions: late-breaking science-drug-eluting stents. Circulation 2001; 104: E 9052.
• 23 Gardiner GA, Meyerovitz MF, Stokes KR. et al. Complications of transluminal angioplasty. Radiology 1986; 159: 201-8.
• 24 Gray B, Sullivan TM, Childs MB. et al. High incidence of restenosis/reocclusion of stents in the percutaneous treatment of long-segment superficial femoral artery disease after suboptimal angioplasty. J Vasc Surg 1997; 25: 74-83.
• 25 Grimm J, Mueller-Huelsbeck S, Jahnke T. et al. Randomized study to compare PTA alone versus PTA with Palmaz stent placement for femoropopliteal lesions. J Vasc Interv Radiol 2001; 12: 935-41.
• 26 Gruentzig A, Hopff H. Percutaneous recanalization after chronic arterial occlusions with a new dilator-catheter. Dtsch Med Wochenschr 1974; 99: 2502-10.
• 27 Guenther RW, Vorwerk D, Bohndorf K. et al. Iliac and femoral artery stenoses and occlusions: treatment by a self expandable stent. Radiology 1989; 172: 725-30.
• 28 Hehrlein C, Stintz M, Kinschert R. Pure beta-particle emitting stents inhibit neointimal formation in rabbits. Circulation 1996; 93: 641-5.
• 29 Heiss HW, Just H, Middleton D. et al. Reocclusion prophylaxis with dipyridamole combined with acetylsalicylic acid following PTA. Angiology 1990; 41: 263-9.
• 30 Henry M, Armor M, Ethevenot G. et al. Palmaz stent placement in iliac and femoropopliteal arteries: primary and secondary patency in 310 patients with 2-4 year follow up. Radiology 1995; 197: 167-74.
• 31 Hoher M, Wohrle J, Wohlfrom M. et al. Intracoronary beta-irradiation with a liquid (188) refilled balloon: six-month results from a clinical safety and feasibility study. Circulation 2000; 101: 2355-60.
• 32 Hunink MGM, Wong JB, Donaldson MC. et al. Revascularization of femoropopliteal artery disease: a decision and cost effective analysis. JAMA 1995; 274: 165-71.
• 33 Jeans WD, Armstrong S, Cole SE. et al. Fate of patients undergoing transluminal angioplasty for lower-limb ischemia. Radiology 1990; 177: 559-64.
• 34 Johnston KW. Femoral and popliteal arteries: re-analyses of results of balloon angioplasty. Radiology 1992; 183: 767-71.
• 35 Kastrati A, Schuhlen H, Hausleiter J. et al. Restenosis after coronary stent placement and randomization to a 4-week combined antiplatelet or anticoagulant therapy: six-month angiographic follow-up of the Intracoronary Stenting and Antithrombotic Regimen (ISAR) trial. Circulation 1997; 96: 462-7.
• 36 Krepel VM, van Andel GJ, van Erp WF. et al. Percutaneous transluminal angioplasty of the femoropopliteal artery: initial and long-term results. Radiology 1985; 156: 325-8.
• 37 Lablanche JM, McFadden EP, Meneveau N. et al. Effect of nadroparin, a low-molecular-weight heparin, on clinical and angiographic restenosis after coronary balloon angioplasty: the FACT study. Circulation 1997; 96: 3396-402.
• 38 Lammer J, Dake MD, Bleyn J. et al. Peripheral arterial obstruction: prospective study of treatment with a transluminally placed self-expanding stent-graft. Radiology 2000; 217: 95-104.
• 39 Lammer J. Femoropopliteal artery obstruction: from the balloon to the stent-graft. Cardiovasc Interv Radiol 2001; 24: 73-83.
• 40 Leon MN, Baim DS, Popma JJ. et al. A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. N Engl J Med 1998; 339: 1665-75.
• 41 Liermann D, Kirchner J. Kathetergestützte Rezidivprophylaxe. In: Vallbracht C, Roth FJ, Strauss AL. (Hrsg). Interventionelle Gefäßtherapie. Darmstadt: Steinkopff; 2002
• 42 Liermann D, Kirchner J, Bauernsachs R. et al. Brachytherapy with Iridium-192 HDR to prevent from restenosis in peripheral arteries. An update. Herz 1998; 23: 394-400.
• 43 Liermann DD, Bauersachs R, Schopohl B. et al. Five year follow-up after brachytherapy for restenosis in peripheral arteries. Semin Interv Cardiol 1997; 2: 133-7.
• 44 Liermann D, Kirchner J. Angiographische Diagnostik und Therapie. Stuttgart, New York: Thieme; 1997
• 45 Liermann D, Böttcher HD, Kollath J. et al. Prophylactic endovascular radiotherapy to prevent intimal hyperplasia after stent implantation in femoropopliteal arteries. Cardiovasc Intervent Radiol 1994; 17: 12-6.
• 46 Liermann D, Strecker EP, Peters J. The Strecker stent: indications and results in iliac and femoropopliteal arteries. Cardiovasc Interv Radiol 1992; 15: 298-305.
• 47 Link J, Mueller-Huelsbeck S, Brossmann J. et al. Perivascular inflammatory reaction after percutaneous placement of covered stents. Cardiovasc Interv Radiol 1996; 19: 345-7.
• 48 Lyon RT, Zarins CK, Lu CT. et al. Vessel, plaque, and lumen morphology after transluminal balloon angioplasty: quantitative study in distended human arteries. Arteriosclerosis 1987; 7: 306-14.
• 49 Martin EC, Katzen BT, Benenati JF. et al. Multicenter trial of the Wallstent in the iliac and femoral arteries. J Vasc Interv Radiol 1995; 6: 843-9.
• 50 Matsi PJ, Manninen HI, Vanninen RL. et al. Femoropopliteal angioplasty in patients with claudication: primary and secondary patency in 140 limbs with 1-3 year follow-up. Radiology 1994; 191: 727-33.
• 51 MERCATOR study group. Does the new angiotensin converting enzyme inhibitor cilazapril prevent restenosis after percutaneous transluminal coronary angioplasty?: Results of the MERCATOR study: a multicenter, randomized, double-blind placebo-controlled trial. Multicenter European Research Trial with Cilazapril after Angioplasty to Prevent Transluminal Coronary Obstruction and Restenosis (MERCATOR) Study Group. Circulation 1992; 86: 100-10.
• 52 Minar E. Medikamentöse Rezidivprophylaxe. In: Vallbracht C, Roth FJ, Strauss AL. (Hrsg). Interventionelle Gefäßtherapie. Darmstadt: Steinkopff; 2002
• 53 Minar E, Pokrajac B, Ahmadi R. et al. Brachytherapy for prophylaxis of restenosis after long-segment femoropopliteal angioplasty: pilot study. Radiology 1998; 208: 173-9.
• 54 Minar E, Pokrajac B, Maca T. et al. Endovascular brachytherapy for prophylaxis of restenosis after femoropopliteal angioplasty: results of a prospective randomized study. Circulation 2000; 102: 2694-9.
• 55 Minar E, Ahmadi R, Koppensteiner R. et al. Comparison of effects of high-dose and low-dose aspirin on restenosis after femoropopliteal percutaneous transluminal angioplasty. Circulation 1995; 91: 2167-73.
• 56 Moussa I, Oetgen M, Roubin G. et al. Effectiveness of clopidogrel and aspirin versus ticlopidine and aspirin in preventing stent thrombosis after coronary stent implantation. Circulation 1999; 99: 2364-6.
• 57 Murray JG, Apthorp LA, Wilkins RA. Long-segment (>10 cm) femoropopliteal angioplasty: improved technical success and long-term patency. Radiology 1995; 195: 158-62.
• 58 Oberhoff M, Herdeg C, Baumbach A. et al. Stent-based antirestenotic coatings (Sirolimus/Paclitaxel). Cathet Cardiovasc Intervent 2002; 55: 404-8.
• 59 Palmaz JC, Sibbitt RR, Reuter SR. et al. Expandable intraluminal graft: a preliminary study. Radiology 1985; 156: 73-7.
• 60 Palmaz JC. Intravascular stents: tissue-stent interactions and design considerations. Am J Radiol 1993; 160: 613-8.
• 61 Richter GM, Palmaz JC, Noeldge G. et al. Relationship between blood flow, thrombus, and neointima in stents. J Vasc Interv Radiol 1999; 10: 598-604.
• 62 Rosenfield K, Schainfeld R, Pieczek A. et al. Restenosis of endovascular stents from stent compression. J Am Coll Cardiol 1997; 29: 328-38.
• 63 Rousseau HP, Raillat CR, Joffre FG. et al. Treatment of femoropopliteal stenoses by means of self-expandable endoprotheses: midterm results. Radiology 1989; 172: 961-4.
• 64 Rupprecht HJ, Darius H, Borkowski U. et al. Comparison of antiplatelet effects of aspirin, ticlopidine, or their combination after stent implantation. Circulation 1998; 97: 1046-52.
• 65 Rutherford RB, Becker GJ. Standards for evaluating and reporting the results of surgical and percutaneous therapy for peripheral arterial disease. Radiology 1990; 181: 277-81.
• 66 Sabate M, Costa MA, Kozuma K. et al. Geographic miss: a cause of treatment failure in radio-oncology applied to intracoronary radiation therapy. Circulation 2000; 101: 2467-71.
• 67 Sapoval MR, Long AL, Raynaud AC. et al. Femoropopliteal stent placement: long-term results. Radiology 1992; 184: 833-9.
• 68 Scarborough R, Kleiman N, Phillips D. Platelet glycoprotein Iib/IIIa antagonists. What are the relevant issues concerning their pharmacology and clinical use?. Circulation 1999; 100: 437-44.
• 69 Schopohl B, Liermann DD, Pohlit R. et al. 192IR endovascular brachytherapy for avoidance of intimal hyperplasia after percutaneous transluminal angioplasty and stent implantation in peripheral vessels: 6 years of experience. Int J Radia Onco Biol Phys 1996; 36: 835-40.
• 70 Schwartz RS. The vessel wall reaction in restenosis. Semin Interv Cardiol 1997; 2: 83-8.
• 71 Schweizer J, Kirch W, Koch R. et al. Effect of high dose Verapamil on restenosis after peripheral angioplasty. J Am Coll Cardiol 1998; 31: 1299-305.
• 72 Serruys PW, van Hout B, Bonnier B. et al. Randomised comparison of implantation of heparin-coated stents with balloon angioplasty in selected patients with coronary artery disease. Lancet 1998; 352: 1478-82.
• 73 Sousa JE, Costa MA, Abizaid AC. et al. Sustained suppression of neointimal proliferation by sirolimus-eluting stents: one-year angiographic and intravascular ultrasound follow-up. Circulation 2001; 104: 2007-11.
• 74 Spies JB, Bakal CW, Burke DR. et al. Standards of Practice Committee of the Society of Cardiovascular and Interventional Radiology. Guidelines for percutaneous transluminal angioplasty. Radiology 1990; 177: 619-26.
• 75 Study group on pharmacological treatment after PTA. Platelet inhibition with ASA/dipyridamole after percutaneous balloon angioplasty in patients with symptomatic lower limb arterial disease: a prospective double-blind trial. Eur J Vasc Surg 1994; 8: 83-8.
• 76 Strauss AL. Becken- und Beinarterien. In: Vallbracht C, Roth FJ, Strauss AL. (Hrsg). Interventionelle Gefäßtherapie. Darmstadt: Steinkopff; 2002
• 77 Strauss AL, Roth FJ, Lutter EM. et al. Determinanten der Langzeitergebnisse der iliakalen und femoropoplitealen Ballon-Angioplastie. VASA 1995; 45 (Suppl): 59.
• 78 Strecker EP, Boos IB, Göttmann D. Femoropopliteal artery stent placement: evaluation of long-term success. Radiology 1997; 205: 375-83.
• 79 TASC. TransAtlantic InterSociety Consensus (TASC) document on management of peripheral arterial disease. J Vasc Surg 2000; 31 (Suppl): 1-296.
• 80 Therasse E, Soulez G, Cartier P. et al. Infection with fatal outcome after endovascular metallic stent placement. Radiology 1994; 192: 363-5.
• 81 Verin V, Popowski Y, de Bruyne B. et al. Endoluminal beta-radiation therapy for the prevention of of coronary restenosis after balloon angioplasty. The Dose-Finding Study Group. N Engl J Med 2001; 344: 243-9.
• 82 Virmani R, Kolodgie FD, Dake MD. et al. Histopathologic evaluation of an expanded polytetrafluoroethylene-nitinol stent endoprothesis in canine iliofemoral arteries. J Vasc Interv Radiol 1999; 10: 445-56.
• 83 Von Essen R, Ostermaier R, Grube E. et al. Prevention of restenosis following angioplasty with octreotide: VERAS. Circulation 1997; 96: 1482-7.
• 84 Vroegindeweij D, Vos LD, Tielbeek AV. et al. Balloon angioplasty combined with primary stenting versus balloon angioplasty alone in femoropopliteal obstructions: a comparative randomized trial. Cardiovasc Interv Radiol 1997; 20: 420-5.
• 85 Waksman R, Laird JR, Jurkovitz CT. et al. Intravascular radiation therapy after balloon angioplasty of narrowed femoropopliteal arteries to prevent restenosis: results of the PARIS feasibility clinical trial. J Vasc Interv Radiol 2001; 12: 915-21.
• 86 Waksman R, White LR, Chan RC. et al. Intracoronary γ-radiation therapy after angioplasty inhibits recurrence in patients with in-stent restenosis (γ-WRIST). Circulation 2000; 101: 2165-71.
• 87 Waksman R, Bhargava B, Leon MB. Late thrombosis following intracoronary brachytherapy. Catheter Cardiovasc Interv 2000; 49: 344-7.
• 88 Waksman R. Late thrombosis after radiation. Sitting on a time bomb. Circulation 1999; 100: 780-2.
• 89 Waksman R, Robinson KA, Crocker IR. et al. Intracoronary low-dose beta-irradiation inhibits neointima formation after coronary artery balloon injury in the swine restenosis model. Circulation 1995; 92: 3025-31.
• 90 Waksman R, Robinson KA, Crocker IR. et al. Endovascular low-dose irradiation inhibits neointima formation after coronary artery balloon injury in swine.A possible role for radiation therapy in restenosis prevention. Circulation 1995; 91: 1533-9.
• 91 Weinberger J, Amols H, Ennis RD. et al. Intracoronary irradiation: dose response for the prevention of restenosis in swine. Int J Radiat Oncol Biol Phys 1996; 36: 767-75.
• 92 White GH, Liew SC, Waugh RC. et al. Early outcome of intermediate follow-up of vascular stents in the femoral and popliteal arteries without long term anticoagulation. J Vasc Surg 1995; 21: 279-81.
• 93 Zeitler E, Schoop W, Zahnow W. The treatment of occlusive arterial disease by transluminal catheter angioplasty. Radiology 1971; 99: 19-26.
• 94 Zollikofer CL, Antonucci F, Pfyffer M. et al. Arterial stent placement with use of the Wallstent: midterm results of clinical experience. Radiology 1991; 179: 449-56.
• 95 Zollikofer CL, Salomonowitz E, Sibley R. et al. Transluminal angioplasty evaluated by electron microscopy. Radiology 1984; 153: 369-74.