Korean J Radiol.  2011 Apr;12(2):203-209. 10.3348/kjr.2011.12.2.203.

The Primary Patency and Fracture Rates of Self-Expandable Nitinol Stents Placed in the Popliteal Arteries, Especially in the P2 and P3 Segments, in Korean Patients

• Chang IS
• Chee HK
• Park SW
• Yun IJ
• Hwang JJ
• Lee SA
• Kim JS
• Chang SH
• Jung HG

• KMID: 1088565
• DOI: http://doi.org/10.3348/kjr.2011.12.2.203

Abstract

OBJECTIVE
We wanted to evaluate the status of self-expandable nitinol stents implanted in the P2 and P3 segments of the popliteal artery in Korean patients.
MATERIALS AND METHODS
We retrospectively analyzed 189 consecutive patients who underwent endovascular treatment for stenoocclusive lesions in the femoropopliteal artery from July 2003 to March 2009, and 18 patients who underwent stent placement in popliteal arterial P2 and P3 segments were finally enrolled. Lesion patency was evaluated by ultrasound or CT angiography, and stent fracture was assessed by plain X-rays at 1, 3, 6 and 12 months and annually thereafter.
RESULTS
At the 1-month follow-up, stent fracture (Type 2) was seen in one limb (up to P3, 1 of 18, 6%) and it was identified in seven limbs at the 3-month follow-up (Type 2, Type 3, Type 4) (n = 1: up to P2; n = 6: P3). At the 6-month follow-up, one more fracture (Type 1) (up to P3) was noted. At the 1-year follow-up, there were no additional stent fractures. Just four limbs (up to P2) at the 2-year follow-up did not have stent fracture. The primary patency was 94%, 61% and 44% at 1, 3 and 6 months, respectively, and the group with stent implantation up to P3 had a higher fracture rate than that of the group that underwent stenting up to P2 (p < 0.05).
CONCLUSION
We suggest that stent placement up to the popliteal arterial P3 segment and over P2 in an Asian population can worsen the stent patency owing to stent fracture. It may be necessary to develop a stent design and structure for the Asian population that can resist the bending force in the knee joint.

Keyword

Artery; Stent; Intervention; Fluoroscopy; Fracture; Angioplasty

MeSH Terms

Aged
Aged, 80 and over
Alloys
Angiography
Arterial Occlusive Diseases/radiography/*therapy/ultrasonography
Chi-Square Distribution
Female
Fluoroscopy
Humans
Korea
Leg/blood supply
Male
Middle Aged
Peripheral Vascular Diseases/radiography/*therapy/ultrasonography
*Popliteal Artery
Prosthesis Failure
Retrospective Studies
*Stents
Tomography, X-Ray Computed
Ultrasonography, Doppler, Color
Ultrasonography, Doppler, Duplex
Vascular Patency

Figure

• 

  Fig. 1 66-year-old man had symptoms of severe intermittent claudication in his left leg. He had chronic total occlusion in distal superficial artery and popliteal artery. He underwent stent placement up to P2 segment for bail-out after failed balloon angioplasty. Type 1 stent fracture (arrow) was detected on fluoroscopy at 3-month follow-up.

• 

  Fig. 2 74-year-old man had diabetes with resting pain in his right foot. He had chronic total occlusion in distal superficial femoral artery and popliteal artery. He underwent stent placement up to P3 segment for bail-out after failed balloon angioplasty. At 3-month follow-up, his symptoms had recurred and type 2 stent fracture (arrows) was detected on fluoroscopy.

• 

  Fig. 3 87-year-old man had diabetes with resting pain in his right foot. He had chronic total occlusion from mid-superficial femoral artery to popliteal arterial P3 segment with massive calcifications (arrowheads). Therefore, he underwent primary stenting there. However, at 3-month follow-up, his symptoms had recurred and type 2, 3 and 4 fractures (arrows) were detected on fluoroscopy.

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