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Monday, August 13, 2018

Use of the Gore Tigris Vascular Stent in Advanced Femoropopliteal Peripheral Arterial Disease


Summary


In a recent study from University of Siena, Italy, researchers published their experience on the new Tigris vascular stent (Gore) for complex femoropopliteal arterial disease. This is a self-expanding stent made of helically wound nitinol wire interconnected by an expanded poly- tetrafluorethylene (ePTFE) structure coated with bonded heparin. In this prospective study 31 patients with Rutherford stage 3 or greater and TASC type B or greater were included. The lesions were located in the common femoral, superficial femoral, popliteal arteries and a femoropopliteal bypass. There were 18 occlusions (58.1%) and 13 stenoses (41.9%). The mean diseased segment length was 15.5 ± 9.9 cm. Patients were treated with Tigris stent alone or in combination with the Viabahn stent (Gore). Technical success was 100% without complications. Primary patency rates at 6, 9, 12, and 15 months were, respectively, 100%, 90.5%, 88.9%, and 80%. Median postprocedural Rutherford stage was 1. Three occlusions occurred, leading to TLR of 9.7% and secondary patency of 100% at 15 months. Intrastent restenosis occurred in four cases (12.9%) without worsening symptoms. Lesion length was associated with re-occlusion (P < 0.003). No stent fractures were observed. The authors concluded that the Tigris stent alone or in combination with a Viabahn stent has an acceptable 12-month primary patency and low reintervention rate for femoropopliteal TASC B–D lesions.



Figure 3. An 83-year-old man with claudication (<100 mt) with TASC D popliteal (P1–P3) chronic occlusion. (a) Angiography demonstratcomplete occlusion of the P1–P3 segments, with hypertrophy of the geniculate vessel arising from the proximal edge of the occluded segment (asterisk). (b) Angiography performed with the knee (d) extended and (e) flexed demonstrate patency of the 5 _ 100 mm Tigris vascular stent. (c–f) 15-Month ultrasound follow-up. (c) Color Doppler examination confirms patency of the collateral geniculate vessel arising from the proximal edge of the stented segments (asterisk in a,c). (d–f) Color Doppler in-stent evaluation from proximal to distal demonstrates progressive increase of the peak systolic values until a ratio >2.0 is reached, indicating in-stent restenosis.

Commentary


Despite the fact that endovascular recanalization has become the first option in many cases of peripheral arterial disease, the femoropopliteal segment remains a challenging territory given its biomechanical properties. Therefore, technological advancements are welcome to help overcome the limitations of the current devices and improve clinical results. Over the years, new options have become available, including drug-eluting and interwoven stents. The Viabahn stent despite its great flexibility may lead to occlusion of collateral circulation, since it is a covered stent. The present study showed that this new Tigris stent (self-expanding non-covered) might be another valuable tool, especially for the distal SFA and popliteal artery, where accentuated “bending” forces are applied and many important collateral vessels are present.

Click here for abstract

Post Author:
Ricardo Yamada, MD
Assistant Professor
Department of Radiology
Division of Vascular and Interventional Radiology
Medical University of South Carolina

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