Editor's Choice – Covered vs. Bare Metal Stents in the Reconstruction of the Aortic Bifurcation: Early and Midterm Outcomes from the COBRA European Multicentre Registry

Saratzis, A; Argriou, A; Davies, R; Bisdas, T; Chaudhuri, A; Torsello, G; Stavroulakis, K; Zayed, H; COBRA Collaborative

Editor's Choice – Covered vs. Bare Metal Stents in the Reconstruction of the Aortic Bifurcation: Early and Midterm Outcomes from the COBRA European Multicentre Registry

Authors

Saratzis, A

Argriou, A

Davies, R

Bisdas, T

Chaudhuri, A

Torsello, G

Stavroulakis, K

Zayed, H

COBRA Collaborative

Issue Date

2022

Type

Scientific Paper

Keywords

Research Subject Categories::MEDICINE::Dermatology and venerology,clinical genetics, internal medicine::Internal medicine::Cardiology

Abstract

Abstract Objective: To report outcomes following endovascular revascularisation for severe aorto-iliac occlusive disease (AIOD) using covered (CS) or bare metal (BMS) stent(s). Methods: This was a retrospective cohort study including patients who underwent treatment with CS or BMS for AIOD between November 2012 and March 2020 in 12 European centres. Outcome measures included death, freedom from target lesion revascularisation (TLR), major amputation, and major adverse cardiac and cerebrovascular events (MACCE). Results: Overall, 252 patients (53% males; mean age 65 ± 10 years) were included (102 with a bare metal and 150 with a covered aortic stent); 122 (48%) presented with chronic limb threatening ischaemia (CLTI). Severe arterial calcification was noted in > 65% of patients, 70% presented with Trans-Atlantic Societies Consensus (TASC) D lesions, 32% and 46% had aortic or iliac chronic total occlusion (CTO), respectively. Median follow up was 17 months (range 6 - 40; none lost to follow up). Median inpatient stay was two days (range two to four). During the first 30 days, two patients died (both with covered aortic stents, because of cardiovascular events), none required TLR, two (1%) patients had a major amputation (all presented with CLTI), and three (1%) had a MACCE. At 17 months, mortality (BMS 14% vs. CS 7%, hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.42 - 2.26, p = .94, log rank test) and TLR (11% vs. 10%, HR 1.98, 95% CI 0.89 - 4.43, p = .095) did not differ statistically significantly between the two groups; only three patients had a major limb amputation during late follow up (all with a covered stent). In a multivariable model, the use of an aortic CS did not influence TLR. In a conditional Cox regression, however, the concomitant use of aortic and iliac CSs was associated with improved freedom from TLR. Conclusion: Endovascular reconstruction with aortic CSs or BMSs for severe AIOD showed comparable midterm performance. The use of both aortic and iliac CSs seems to be associated with reduced TLR. Keywords: Aorto-iliac disease; Chronic limb threatening ischaemia; Claudication; Endovascular; Peripheral arterial disease; Revascularisation. Copyright © 2021 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved. PubMed Disclaimer Similar articles Efficacy and Safety of Covered Stents Versus Bare-Metal Stents for Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis. Hu C, Chen L, Wu M, Ye Q, Zou J, Zhao B, Li X, Wu H. J Endovasc Ther. 2024 Mar 16:15266028241237387. doi: 10.1177/15266028241237387. Online ahead of print. PMID: 38491926 Review. Outcomes of covered vs bare metal stents for the treatment of aortoiliac occlusive disease. Li J, Shen C, Zhang Y, Fang J, Qu C, Teng L. J Vasc Surg. 2024 Feb;79(2):330-338. doi: 10.1016/j.jvs.2023.09.034. Epub 2023 Oct 5. PMID: 37802401 Treatment of Aortoiliac Occlusive Disease With the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) Technique: Results of a UK Multicenter Study. Saratzis A, Salem M, Sabbagh C, Abisi S, Huasen B, Egun A, Nash J, Lau PF, Chaudhuri A, Dey R, Patrone L, Malina M, Davies R, Zayed H. J Endovasc Ther. 2021 Oct;28(5):737-745. doi: 10.1177/15266028211025028. Epub 2021 Jun 23. PMID: 34160321 Covered versus bare metal kissing stents for reconstruction of the aortic bifurcation in the ILIACS registry. Squizzato F, Piazza M, Pulli R, Fargion A, Piffaretti G, Pratesi C, Grego F, Antonello M; ILIACS Registry Group. J Vasc Surg. 2021 Jun;73(6):1980-1990.e4. doi: 10.1016/j.jvs.2020.10.066. Epub 2020 Nov 28. PMID: 33253875 Clinical Effectiveness and Cost Effectiveness of Intracoronary Brachytherapy and Drug Eluting Stents [Internet]. Mørland B, Kløw NE, Rotevatn S, Steigen T, Vatne K, Wisløff T, Kristiansen IS, Norderhaug I. Oslo, Norway: Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH); 2004. Report from Norwegian Knowledge Centre for the Health Services (NOKC) No. 08-2004. PMID: 29320006 Free Books & Documents. Review. See all similar articles Related information MedGen LinkOut - more resources Full Text Sources Elsevier Science

Citation

Saratzis A, Argyriou A, Davies R, Bisdas T, Chaudhuri A, Torsello G, Stavroulakis K, Zayed H; COBRA collaborative. Editor's Choice - Covered vs. Bare Metal Stents in the Reconstruction of the Aortic Bifurcation: Early and Midterm Outcomes from the COBRA European Multicentre Registry. Eur J Vasc Endovasc Surg. 2022 May;63(5):688-695. doi: 10.1016/j.ejvs.2021.12.020. Epub 2022 Mar 22. PMID: 35337725.