Comparison of covered stents versus bare metal stents for treatment of chronic atherosclerotic mesenteric arterial disease

Objective: To compare outcomes of mesenteric angioplasty and stenting using iCAST covered stents (CS; Atrium, Hudson, NH) or bare metal stents (BMS) in patients with chronic mesenteric ischemia (CMI). Methods: We reviewed the clinical data of 225 patients (65 male and 160 female; mean age, 72 ± 12 years) treated for CMI at two academic centers (2000-2010). Outcomes were analyzed in patients who had primary intervention or reintervention using BMS (n = 164 patients/197 vessels) or CS (n = 61 patients/67 vessels). End points were freedom from restenosis, symptom recurrence, reinterventions, and patency rates. Results: Patients in both groups had similar demographics, cardiovascular risk factors, and extent of disease. In the primary intervention group (mean follow-up, 29 ± 12 months), patients treated by CS had higher freedom from restenosis (92% ± 6% vs 53% ± 4%; P =.003), symptom recurrence (92 ± 4% vs 50 ± 5%; P =.003), reintervention (91% ± 6% vs 56% ± 5%; P =.005), and better primary patency at 3 years (92% ± 6% vs 52% ± 5%; P <.003) than for BMS. In the reintervention group (mean follow-up, 24 ± 9 months), patients treated by CS had higher freedom from restenosis (89% ± 10% vs 49% ± 14%; P <.04), symptom recurrence (100% vs 64%± 9%; P =.001), and reintervention (100% vs 72% ± 9%; P =.03) at 1 year, and a trend toward improved primary patency at 1 year (100% vs 63% ± 9%; P =.054). Secondary patency rates were similar in both groups. Conclusions: In this nonrandomized study, CS were associated with less restenosis, recurrences, and reinterventions than BMS in patients undergoing primary interventions or reinterventions for CMI.