Stenting of Superior Mesenteric Artery (SMA) Stenosis: Covered Stent May Produce Better Results
Endovascular treatment of superior mesenteric artery (SMA) stenosis has been in practice for approximately 20 years. It is the preferred initial therapy for the vast majority of patients presenting with chronic mesenteric ischemia. The usual approach involves balloon angioplasty and stenting with a balloon-expandable (preferably) or self-expanding bare-metal device.
While initial clinical results of SMA stenting are generally quite satisfactory, most experts and experienced operators have become somewhat disenchanted with such therapy because of the frequent occurrence of restenosis of the stented vessel (in up to 30% of cases or more) and need for reinterventions. But good news may be just around the corner as recently released new data show that use of covered stents in the SMA would appear to produce better outcomes.
At the recent Vascular Annual Meeting (VAM) of the SVS last June (National Harbor, MD), vascular surgeons from the Mayo Clinic and the University of Tennessee at Chattanooga presented a comparison of outcomes using angioplasty and stenting with iCast covered stents (Atrium Medical Corporation) versus bare-metal stents in patients with chronic mesenteric ischemia (CMI). “We reviewed the clinical data of nonrandomized 225 patients (65 male and 160 female; mean age, 72 ± 12 years) treated for CMI (2000-2010),” commented Dr. Gustavo S. Oderich (from Mayo) in the SVS press release. “Outcomes were analyzed in patients who had primary intervention or reintervention using bare-metal stents (164 patients, 197 vessels) or covered stents (61 patients, 67 vessels). Endpoints were freedom from restenosis, recurrence, and reintervention, and primary and secondary patency rates.” As summarized in the press release, patients in both groups had similar demographics, cardiovascular risk factors, and extent of disease. Mean follow-up was 27 ± 12 months. The investigators found that patients treated with covered stents had less restenosis, recurrences, and reinterventions compared to those treated with bare-metal stents, both in the primary intervention and in the reintervention groups (P < .05). Primary patency at 2 years was significantly higher for covered stents compared to bare-metal stents in the primary intervention group (91±6 vs 60 ± 5; P < .003).