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

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.