Target Lesion Revascularization in Patients with Infrapopliteal Long-Segment Lesions Treated with Overlapping Everolimus-Eluting Coronary Stents

Purpose: To evaluate clinical outcomes in patients with critical limb ischemia (CLI) and long-segment (>38 mm) infrapopliteal lesions treated with everolimus-eluting coronary stents (EESs) with prior failed angioplasty (percutaneous transluminal angioplasty [PTA])

Materials and Methods: We reviewed outcomes in patients with long-segment lesions treated with EESs after failed PTA between January 2009 and September 2018. The primary endpoints were a composite of freedom from death from any cause through 30 days and freedom from target limb major amputation and CD-TLR through 12 months analyzed via the Kaplan-Meier method. Log-rank test was used to compare differences between Rutherford groups (Rutherford 4 and 5 compared with Rutherford 6).

Results: Sixty-three patients (age 73.6 years ± 11.2 years; 4 female, 53 male), with 65 treated limbs met inclusion criteria. Thirty-seven Rutherford 4 or 5 limbs were included, and 28 Rutherford 6 limbs were included. Mean lesion length was 103.1 ± 52.6 mm (44.0–380 mm). The mean number of stents used was 2.8 (range, 2–10 stents) with a mean stent diameter of 3.4 mm (range, 2.5–4.0 mm). There were 11 deaths, 8 major amputations, and 7 CD-TLRs. Freedom from the composite endpoint was 70.6% for all patients. Patients with Rutherford 4 and 5 had a 84.6% freedom compared with those with Rutherford 6 with a 52.5% freedom from composite endpoint (hazard ratio, 4.0; 95% confidence interval, 1.5–10.6; P = 0.0059).

Conclusions: In patients with CLI, placement of multiple EESs in long-segment infrapopliteal lesions with prior failed PTA is a durable treatment option, with Rutherford 4 and 5 patients demonstrating markedly better outcomes as measured by freedom from death from any cause through 30 days and freedom from target limb amputation and CD-TLR through 12 months compared with Rutherford 6 patients.J. Watchmaker, R. Lookstein