Bypass Surgery vs. Drug-Eluting Stent for Trans-Atlantic Inter-Society Consensus-II (TASCII) C or D Femoropopliteal Lesions

Yoshimitsu Soga, Mitsuyoshi Takahara, Osamu Iida, Shinsuke Mii, Jin Okazaki, Masatsugu Nakano, Yasutaka Yamauchi, Kenji Ando
2015 Circulation Journal  
2688 SOGA Y et al. Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp However, there has not been a comparison of the outcomes of BSX and DES placement for TASCII C/D lesions. Here, we report the 1-year patency after DES placement vs. BSX using the propensity score-matching method. Methods Study Population The DES group was a subgroup of the prospective multicenter ZEPHYR (ZilvEr PTX for tHe Femoral ArterY and Proximal Popliteal ArteRy) study, 10
more » ... ich was registered in the University Hospital Medical Information Network Clinical Trial Registry (UMIN-CTR) approved by the International Committee of Medical Journal Editors (no. UMIN000008433). The he Trans-Atlantic Inter-Society Consensus-II (TASCII) recommends bypass surgery (BSX) as the first-line therapy for TASCII C/D femoropopliteal (FP) lesions, instead of endovascular therapy (EVT). 1 Several studies have shown that a novel bare nitinol stent decreases the restenosis rate in the short and medium term compared with conventional balloon angioplasty. 2-5 However, those studies focused on TASCII A/B lesions, rather than the more complex TASCII C/D lesions. Patency is also known to decrease for longer lesions and the efficacy of bare nitinol stent placement is not comparable to that of BSX for long lesions. Recent reports have shown that a drug-eluting stent (DES) gives excellent short-and medium-term outcomes, 6-8 and that a DES may also improve the outcomes for TASCII C/D lesions. 9 T Background: Bypass surgery (BSX) as first-line therapy for Trans-Atlantic Inter-Society Consensus-II (TASCII) C/D femoropopliteal (FP) lesions is recommended. Recent reports have shown that a drug-eluting stent (DES) provides good durability up to the mid-term. We investigated clinical outcomes after BSX vs. DES for TASCII C/D FP lesions. Methods and Results : As treatment of de novo TASCII C/D FP lesions, 274 patients who underwent DES implantation and 201 patients who had BSX were identified and analyzed. Each group had at least 1 year of follow-up data. The primary endpoint was binary restenosis. Secondary endpoints were major amputation, reintervention, reocclusion and major adverse limb event (MALE; including major amputation or any reintervention and restenosis). Before matching, the binary restenosis rate was significantly higher in the DES group than in the BSX group (42% vs. 18%, P<0.001). After propensity matching, the 1-year restenosis rate was still higher in the DES group (44% vs. 18%, P<0.001). The DES group also had a significantly higher incidence of reintervention and MALE. Major amputation and reocclusion showed no significant difference. The subsequent stratification analysis reconfirmed no significant interaction effect of any background characteristics on the association of DES implantation vs. BSX with the 1-year restenosis risk. Conclusions: BSX is still a feasible and recommended treatment for TASCII C/D FP lesions in Japanese patients, based on good durability up to 1 year. (Circ J 2015; 79: 2688 -2695
doi:10.1253/circj.cj-15-0597 pmid:26466986 fatcat:haxi5glh5zchxb7e7jorfpgpme