Direct stent placement vs percutaneous mechanical thrombectomy in selected patients with acute lower limb ischemia: short and long-term outcomes.

IF 2.6 3区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of Vascular and Interventional Radiology Pub Date : 2025-10-13 DOI:10.1016/j.jvir.2025.10.007

Nikolaos Galanakis, Angeliki Vouidaski, Nikolaos Kontopodis, Michail E Klontzas, Christos V Ioannou, Elias Kehagias

{"title":"Direct stent placement vs percutaneous mechanical thrombectomy in selected patients with acute lower limb ischemia: short and long-term outcomes.","authors":"Nikolaos Galanakis, Angeliki Vouidaski, Nikolaos Kontopodis, Michail E Klontzas, Christos V Ioannou, Elias Kehagias","doi":"10.1016/j.jvir.2025.10.007","DOIUrl":null,"url":null,"abstract":"Purpose: Percutaneous mechanical thrombectomy (PMT) has an evolving role in the treatment of acute lower limb ischemia (ALI). However, PMT devices are not always available. This study compares the safety and effectiveness of direct stent placement (DS) technique versus PMT in patients with ALI.Materials and methods: This 10-year retrospective study included 50 selected patients out of 465 patients presented with ALI (SVS/ISCVS IIa: n=24, SVS/ISCVS IIb: n=26). The underlying causes included in-situ thrombosis (n=41) and embolism (n=9). Patients were treated either with DS technique (n=20) involving deployment of self-expanding stents across acute arterial occlusions, or with PMT (n=30) using Angiojet device.Results: Technical success was achieved in all cases. Access-site adverse events (hematoma, dissection, pseudoaneurysm) occurred in 2 patients in DS and 4 patients in PMT group. No cases of reperfusion injury and one case of distal embolization in PMT group was reported. During follow-up, 2 minor and 2 major amputations were performed in DS group and 3 major and 3 minor amputations in PMT group. Primary patency rates for DS and PMT group were 90% vs 78.6% at 1 year, 84.7% vs 74.2% at 2 years and 69.3% vs 69.6% at 3 years, respectively (p=0.789). Amputation-free survival rates for DS and PMT group were 85% vs 86.7% at 1 year, 72.9% vs 77.5% at 3 years and 65% vs 77.5% at 4 years, respectively (p=0.635).Conclusion: DS seems to be a safe and effective bailout treatment option for ALI, when PMT is unavailable, demonstrating comparable outcomes with PMT.","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Vascular and Interventional Radiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jvir.2025.10.007","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: Percutaneous mechanical thrombectomy (PMT) has an evolving role in the treatment of acute lower limb ischemia (ALI). However, PMT devices are not always available. This study compares the safety and effectiveness of direct stent placement (DS) technique versus PMT in patients with ALI.

Materials and methods: This 10-year retrospective study included 50 selected patients out of 465 patients presented with ALI (SVS/ISCVS IIa: n=24, SVS/ISCVS IIb: n=26). The underlying causes included in-situ thrombosis (n=41) and embolism (n=9). Patients were treated either with DS technique (n=20) involving deployment of self-expanding stents across acute arterial occlusions, or with PMT (n=30) using Angiojet device.

Results: Technical success was achieved in all cases. Access-site adverse events (hematoma, dissection, pseudoaneurysm) occurred in 2 patients in DS and 4 patients in PMT group. No cases of reperfusion injury and one case of distal embolization in PMT group was reported. During follow-up, 2 minor and 2 major amputations were performed in DS group and 3 major and 3 minor amputations in PMT group. Primary patency rates for DS and PMT group were 90% vs 78.6% at 1 year, 84.7% vs 74.2% at 2 years and 69.3% vs 69.6% at 3 years, respectively (p=0.789). Amputation-free survival rates for DS and PMT group were 85% vs 86.7% at 1 year, 72.9% vs 77.5% at 3 years and 65% vs 77.5% at 4 years, respectively (p=0.635).

Conclusion: DS seems to be a safe and effective bailout treatment option for ALI, when PMT is unavailable, demonstrating comparable outcomes with PMT.

查看原文本刊更多论文

急性下肢缺血患者的直接支架置入与经皮机械取栓：短期和长期结果

目的：经皮机械取栓术（PMT）在急性下肢缺血（ALI）治疗中的作用越来越重要。然而，PMT设备并不总是可用的。本研究比较了直接支架置入（DS）技术与PMT在ALI患者中的安全性和有效性。材料和方法：这项为期10年的回顾性研究从465例ALI患者中选择了50例患者（SVS/ISCVS IIa: n=24, SVS/ISCVS IIb: n=26）。病因包括原位血栓形成（n=41）和栓塞（n=9）。患者接受DS技术治疗（n=20），包括在急性动脉闭塞处部署自扩张支架，或使用Angiojet装置进行PMT治疗（n=30）。结果：所有病例均取得技术成功。DS组和PMT组分别有2例和4例患者发生通路不良事件（血肿、夹层、假性动脉瘤）。PMT组无再灌注损伤，远端栓塞1例。随访中，DS组小截肢2例，大截肢2例，PMT组大截肢3例，小截肢3例。DS组和PMT组的原发性通畅率在1年时分别为90% vs 78.6%， 2年时为84.7% vs 74.2%， 3年时为69.3% vs 69.6% （p=0.789）。DS和PMT组1年无截肢生存率分别为85% vs 86.7%， 3年72.9% vs 77.5%， 4年65% vs 77.5% （p=0.635）。结论：当PMT无法获得时，DS似乎是ALI的一种安全有效的救助治疗选择，显示出与PMT相当的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Vascular and Interventional Radiology 医学-核医学

CiteScore

4.30

自引率

10.30%

发文量

942

审稿时长

90 days

期刊介绍： JVIR, published continuously since 1990, is an international, monthly peer-reviewed interventional radiology journal. As the official journal of the Society of Interventional Radiology, JVIR is the peer-reviewed journal of choice for interventional radiologists, radiologists, cardiologists, vascular surgeons, neurosurgeons, and other clinicians who seek current and reliable information on every aspect of vascular and interventional radiology. Each issue of JVIR covers critical and cutting-edge medical minimally invasive, clinical, basic research, radiological, pathological, and socioeconomic issues of importance to the field.