Percutaneous Transluminal Angioplasty and Drug-Eluting Stents for Infrapopliteal Lesions in Critical Limb Ischemia (PADI) Trial

MI Spreen, JM Martens, Bettina Hansen, BM Wisse, E Verheij-Hart, LC van Dijk, JPPM de Vries, JA Vos, GJ de Borst, EJPA Vonken, JJ Wever, RGS van Eps, WPTM Mali, H Overhagen

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Abstract

Background- Endovascular infrapopliteal treatment of patients with critical limb ischemia using percutaneous transluminal angioplasty (PTA) and bail-out bare metal stenting (BMS) is hampered by restenosis. In interventional cardiology, drug-eluting stents (DES) have shown better patency rates and are standard practice nowadays. An investigator-initiated, multicenter, randomized trial was conducted to assess whether DES also improve patency and clinical outcome of infrapopliteal lesions. Methods and Results- Adults with critical limb ischemia (Rutherford category >= 4) and infrapopliteal lesions were randomized to receive PTA +/- BMS or DES with paclitaxel. Primary end point was 6-month primary binary patency of treated lesions, defined as <= 50% stenosis on computed tomographic angiography. Stenosis > 50%, retreatment, major amputation, and critical limb ischemia-related death were regarded as treatment failure. Severity of failure was assessed with an ordinal score, ranging from vessel stenosis through occlusion to the clinical failures. Seventy-four limbs (73 patients) were treated with DES and 66 limbs (64 patients) received PTA +/- BMS. Six-month patency rates were 48.0% for DES and 35.1% for PTA +/- BMS (P=0.096) in the modified-intention-to-treat and 51.9% and 35.1% (P=0.037) in the per-protocol analysis. The ordinal score showed significantly worse treatment failure for PTA +/- BMS versus DES (P=0.041). The observed major amputation rate remained lower in the DES group until 2 years post-treatment, with a trend toward significance (P=0.066). Less minor amputations occurred after DES until 6 months post-treatment (P=0.03). Conclusions- In patients with critical limb ischemia caused by infrapopliteal lesions, DES provide better 6-month patency rates and less amputations after 6 and 12 months compared with PTA +/- BMS. Clinical Trial Registration- URL: [GRAPHICS] . Unique identifier: NCT00471289.
Original languageUndefined/Unknown
JournalCirculation-cardiovascular interventions
Volume9
Issue number2
DOIs
Publication statusPublished - 2016

Research programs

  • EMC MM-04-20-01
  • EMC MM-04-20-02-A

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