Balloon angioplasty versus stenting with nitinol stents in intermediate length superficial femoral artery lesions

<jats:title>Abstract</jats:title><jats:p><jats:styled-content>Background</jats:styled-content>: Recent randomized trials investigating stent implantation compared with balloon angioplasty for treatment of superficial femoral artery (SFA) disease have given divergent results in short (mean 5 cm) and intermediate (mean 10 cm) lesions. We reinvestigated whether primary nitinol stenting is associated with a morphologic and clinical benefit when compared with percutaneous transluminal angioplasty with optional stenting (PTA) in intermediate‐length lesions. <jats:styled-content>Methods</jats:styled-content>: We randomly assigned 73 patients with severe claudication or chronic limb ischemia and average 8 cm long (range 3–20 cm) SFA stenosis or occlusion to primary stent implantation (<jats:italic>n</jats:italic> = 34) or PTA (<jats:italic>n</jats:italic> = 39). Restenosis >50% and clinical outcome were assessed at 3, 6, and 12 months postintervention. <jats:styled-content>Results</jats:styled-content>: Average length of the treated segments was 98 ± 54 mm and 71 ± 43 mm in the stent and PTA groups (<jats:italic>P</jats:italic> = 0.011), respectively. In the PTA group, secondary stenting was performed in 10 of 39 patients (26%) due to a suboptimal result after balloon dilation. Restenosis rates in the stent and PTA groups were 21.9% versus 55.6% (<jats:italic>P</jats:italic> = 0.005) at 6 months by CT‐angiography, and 2.9% versus 18.9% (<jats:italic>P</jats:italic> = 0.033), 18.2% versus 50.0% (<jats:italic>P</jats:italic> = 0.006), and 34.4% versus 61.1% (<jats:italic>P</jats:italic> = 0.028) at 3, 6, and 12 months by sonography, respectively. Clinically, patients in the stent group reported a significantly higher maximum walking capacity compared with the PTA group at 6 and 12 months. <jats:styled-content>Conclusion</jats:styled-content>: In this randomized multicenter trial, primary stenting with a self‐expanding nitinol stent for treatment of intermediate length SFA disease resulted morphologically and clinically superior midterm results compared with balloon angioplasty with optional secondary stenting. © 2009 Wiley‐Liss, Inc.</jats:p>