New Insights in Treating SFA & Popliteal Arteries

There is still considerable uncertainty about the best endovascular treatment strategies for patients with stenosis or occlusion of the superficial femoral artery (SFA) or popliteal artery. Percutaneous transluminal angioplasty (PTA) has been performed for over 30 years now, but there is an evolving body of literature that has documented suboptimal outcomes with PTA for all but only the most focal (<4 cm) femoropopliteal lesions. While there is considerable enthusiasm for atherectomy in some centers, there is a paucity of comparative data demonstrating superiority of any of the atherectomy devices over PTA. Over the years, there has also been controversy about the role of stents in the SFA. Clinicians currently do not have enough data demonstrating the superiority of stenting over PTA, but more research is accumulating in this field. Two randomized trials comparing stenting with PTA in the SFA and proximal popliteal artery have recently been published. Schillinger et al randomized patients with SFA disease to balloon angioplasty with provisional/bailout stent implantation versus primary nitinol stent implantation. At 12 months, there was a significantly lower rate of restenosis in the primary stent group compared with the angioplasty group (37% vs 63%). Krankenberg et al randomized 244 patients with shorter SFA lesions to balloon angioplasty versus implantation of a single nitinol stent. At 12 months, there was no significant difference in restenosis between the treatment groups (31.7% vs 38.6%). The disparate results from these trials can likely be explained by the significant differences in lesion length as well as differences between the two stent designs. The RESILIENT Trial The RESILIENT trial (A Randomized Study Comparing the Edwards Self-Expanding LifeStent vs...