Interwoven Nitinol Stent Versus Laser-Cut-Type Nitinol Stent for Long Femoropopliteal Occlusive Disease: A Propensity Matched Analysis.

Abstract

Purpose: There are still limited data to determine the efficacy of interwoven nitinol stent (INS) compared with laser-cut nitinol stent (CNS) for the endovascular treatment of long femoropopliteal lesions. The aim of this study is to evaluate the short- and mid-term results of the effectiveness of CNS and INS in the revascularization of long femoropopliteal occlusions. We performed analyses of the primary and secondary outcome measures for subgroups of patients with below-the-knee and "above-the-knee" lesions.

Materials and methods: A retrospective propensity matched analysis was conducted on symptomatic patients (Rutherford category 3-6) with long occlusions of the femoropopliteal segment (> 15 cm) who underwent stenting with either INS or CNS from 2012 to 2020. The primary outcome measure was the primary patency in 2 years. Secondary outcome measures were secondary patency, major adverse cardiovascular events, major adverse limb events, sustained clinical improvement, and mortality.

Results: After propensity score matching, 126 and 125 patients remained in the INS and CNS groups, respectively. There were no cases of major cardiovascular events (MACE) or major limb events in both groups during the perioperative period. There were no significant differences in primary and secondary patency during a 2-year follow-up. There were no stent fractures in the INS group, whereas in the CNS group the stent fractures rate reached 37 (29.6%) patients (p < 0.001). In the "above-the-knee" subgroup, INS and CNS showed comparable primary patency rates. However, the secondary patency rates were 82.0% and 96.9% in INS and CNS groups, respectively (p < 0.001). The secondary sustained clinical improvement rates were 79.8% and 93.9% in INS and CNS subgroups, respectively (p < 0.001). In the "below-the-knee subgroup," INS showed higher primary patency rate (INS: 64.9% CNS: 37.1%; p = 0.04). In the CNS group, the fractures rate "below the knee" was statistically significantly higher compared with stents "above the knee" (p = 0.03).

Conclusion: After propensity score matching, INS showed comparable results with CNS for the whole cohort. However, INS seems to achieve better outcomes for femoropopliteal lesion extended to the below-the-knee level.