Primary balloon-expandable covered stents vs. primary bare-stents for mesenteric ischemia: patency and clinical outcomes

Purpose To evaluate the anatomical and functional outcomes of primary balloon-expandable covered stents compared to primary balloon-expandable bare-stents for the endovascular management of chronic mesenteric ischemia. Materials and Methods A retrospective audit of patients undergoing primary endovascular management of mesenteric ischemia was performed (01/2006-12/2011). The cohort was divided into bare-metal stent group (BMG) and covered stent (0.035-inch platform, V-12, Atrium) group (CVG). Inferior mesenteric artery (IMA) arteries (none in CVG) and angioplasty alone (small sample size) were excluded. Patency per artery was determined by imaging follow-up and clinical success (patency by clinical response). Results 111 primary endovascular procedures were found (18 IMA excluded). Technical success of SMA and CAx arteries was 99% (n=110/111). An additional 7 arteries (2 SMA, 5 CAx) in 6 patients were excluded (angioplasty alone). The remainder was: 15 (12 SMA, 3 CAx) arteries in 14 patients (CVG) and 88 (64 SMA, 24 CAx) arteries in 75 patients (BMG). Clinical success per patient for BMG vs. CVG was 87% (n=65/75) vs. 79% (n=11/14) (P=0.3933), respectively. Primary unassisted patency at 6, 9, 12 and 24 months for CVG vs. BMG were: 100%+/-0, 100%+/-0, 100%+/-0, and 100%+/-0 vs. 93%+/-4, 81%+/-6, 74%+/-8, and 45%+/-11, respectively (P Conclusion In patients with mesenteric ischemia, balloon-expandable covered stents have improved patency compared to balloon-expandable bare stents in the celiac axis and superior mesenteric artery.