Stents for The Common Femoral Artery: The Good, The Bad and The Ugly
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1 Stents for The Common Femoral Artery: The Good, The Bad and The Ugly Salman Arain, MD, FACC Assistant Professor of Medicine - Cardiology University of Texas Health Sciences Center Houston Texas, USA
2 Disclosure Speaker name: Salman A. Arain, MD... I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest
3 Introduction The CFA has historically been designated as a no stent zone Treatment of choice - CFA endarterectomy and other surgical repair Concerns about CFA stent placement include Device fracture Kinking Device failure (restenosis) Exclusion of the PFA Re-access for future procedures
4 Percutaneous Treatment of the CFA Not all patients are optimal candidates for CFA surgery Unfavorable clinical features include High medical risk Morbid obesity Prior surgery with failure High calcium burden
5 Percutaneous Treatment of the CFA Ideal strategy needs to be defined Basic principles Angioplasty +/- plaque modification first Stents reserved for failed PTA (ad hoc use) Ideal stent features Flexibility Radial strength Resistance to restenosis Preservation of side branches Ease of delivery
6 Options for Endovascular Treatment Balloon Angioplasty POBA Scoring balloon angioplasty Drug coated balloon angioplasty Atherectomy with PTA Stents Woven nitinol (Supera) Self expanding PTFE covered vs. laser cut nitinol Balloon expandable Bare metal vs. PTFE covered
7 So, what is the good, the bad and the ugly? Balloon Angioplasty POBA high restenosis rates Scoring balloon angioplasty limited data as stand alone therapy Drug coated balloon angioplasty limited data Role of atherectomy not well defined yet
8 So, what is the good, the bad and the ugly? Stent Placement Braided nitinol (Supera) limited data, favorable properties Self expanding some data, some favorable properties PTFE covered vs. laser cut nitinol tube Balloon expandable limited data, limited utility, greatest potential for fracture Bare metal vs. PTFE covered
9 Stent Options for the CFA SUPERA VIABAHN ICAST S.M.A.R.T.
10 Supera in the CFA: 67 year old man with prior CFAE, right FP bypass and progressive claudication. Baseline angio TurboHawk atherectomy Angio post- PTA Angio with 7.5 mm Supera in place
11 Supera in the CFA: 67 year old man with prior CFAE and Supera placement 9 months later Patency 9 mo.s Stent architecture before sheath insertion Micropuncture sheath in stent Stent architecture - final
12 Viabahn in the CFA: 72 year old woman with prior aorto-bifem., right BKA and recurrent right CFA PSA CTA of R CFA Pseudoaneury sm Angio showing extent of PSA
13 Viabahn in the CFA: 72 year old woman with prior aorto-bifem., right BKA and recurrent right CFA PSA Angio after placement of Viabahn Angio after ICAST placement
14 ICAST in the CFA: 83 year old man with right CFA PSA 3 days after high risk Impella supported PCI PSA in the R CFA after 14 Fr access 6 mm ICAST on an 8 mm balloon Post dilation with a 10 mm balloon Final angio
15 SMART in the CFA: 68 year old man with CAD, ICM, PAD and failed right fem.-pop. bypass surgery Baseline Angio Selective RLE angio Re-entry into the true lumen Angio following PTA
16 SMART in the CFA: 68 year old man with CAD, ICM, PAD and failed right fem.-pop. bypass surgery Atherectomy using JetStream Angio after atherectomy Post dilation with a 6 mm balloon Angio placment of a short SES
17 CONCLUSIONS Not all patients with CFA disease are optimal candidates for CFA surgery. There are multiple viable options for percutaneous treatment of the CFA, incl. PTA and/or stent placement. The stent type must be individualized to the clinical situation.
18 Thank You
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