Stenting Shows Positive Results in Mesenteric Artery CTO Lesions

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Endovascular stenting is a safe and effective procedure for patients with chronic ischemia of the superior mesenteric artery due to chronic total occlusions (CTOs), according to results presented Sunday, April 14, 2013, at the Society of Interventional Radiology Scientific Meeting in New Orleans, LA.

Christopher J. Grilli, DO, of Christiana Care Health System (Newark, DE), and colleagues retrospectively reviewed data on 47 symptomatic patients with chronic mesenteric ischemia who underwent endovascular stenting of CTO lesions in the superior mesenteric artery between February 2008 and July 2012.

Forty-one (87.2%) of the procedures were technically successful. Of 6 failures, 2 patients were referred for surgical bypass, 3 underwent celiac artery stenting, and 1 was lost to follow-up. Complete symptomatic relief was reported in 40 (85.1%) patients within 24 hours after the procedure, with 1 patient reporting partial improvement and none reporting stable or worsening of symptoms.

Primary patency was observed in 97% of patients at 12 months and 75% at 24 months. After repeat endovascular procedures in 7 patients with recurrent blockages, patency was observed in all patients at 12 months and 97% at 24 months.

All patients were symptom free at 12 months, and 88% remained so at 24 months. There were 3 (6.4%) minor access-related complications and no major complications.

Opening a Single Blockage Now an Option

Patients with mesenteric ischemia are “sometimes very difficult to diagnose because there are lots of reasons for people to have abdominal pain and it can be very confusing to sort out,” said Christopher J. White, MD, of the Ochsner Heart and Vascular Institute (New Orleans, LA). “Typically, the rule of thumb is that it takes 2 of the 3 arteries to be blocked before anyone will have symptoms.” Patients are rarely symptomatic with only a single blockage, he added.

He told TCTMD in a telephone interview that it has not been common practice to open total occlusions because it was thought that the patients would receive blood flow from the other arteries. “But what they’ve shown in this paper is that they were able to recanalize the occluded artery and get pretty good results,” he said. “That’s laudatory.”

Because of the skill required, this procedure should only be performed by physicians who routinely treat mesenteric arteries, Dr. White stressed.

‘Too Good to Be True’?

Still, “some of their data looks a little too good to be true,” he added. “I don’t know anything that makes 100% of patients better at 1 year. . . . It makes me a little skeptical when people claim such wonderful results when in the literature we know that the [restenosis] rate on an annual basis is somewhere between 20% [and] 25%.”

Noting the somewhat casual use of medical imaging in emergency rooms today, Dr. White warned against the potential danger of relying on imaging alone in this patient population. “CT scans show these arteries blocked all the time,” he said. “But just because there’s a blocked artery doesn’t mean it needs to be treated. . . . You have to figure out which patients really will benefit because there are risks [involved]. These are not benign procedures.”

Going forward, it will be important to see long-term patency, Dr. White noted, “because we know that the Achilles’ heel of stenting is restenosis.” In addition, he said this study will need to be reproduced and confirmed by other institutions.

Study Details

Almost two-thirds of patients (61.7%) were women, and the mean age was 73 years. All patients had postprandial pain and 70% had lost more than 5 pounds.

 


Source:
Grilli CJ, Fedele CR, Tahir OM, et al. Stenting of superior mesenteric artery chronic total occlusions in patients with chronic mesenteric ischemia: Technical and clinical outcomes. Presented at: 38th Annual Society of Interventional Radiology Scientific Meeting; April 14, 2013; New Orleans, LA.

 

 

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Disclosures
  • Drs. Grilli and White report no relevant conflicts of interest.

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