Primary Iliac Stenting versus Iliac Percutaneous Transluminal Angioplasty with Selective Stenting

Objectives: Preferential use of primary iliac stenting versus selective stenting is controversial. This study will compare early and late clinical outcomes of both modalities.
Methods: The early technical and early and late clinical success of 149 iliac stenoses with PTA/primary stenting (Group I) were compared to 41 stenoses with PTA/selective stenting for suboptimal PTA (Group II). All patients were evaluated by duplex scanning/ABIs every six months. Late patency rates were analyzed using the Kaplan-Meier method.<
Results: The mean follow-up was 24 months for Group I versus 34 months for Group II. The perioperative complication rate for Group I was 2.7% versus 24% for Group II (p<0.0001). The early clinical success rate was 97% for Group I versus 83% for Group II (p=0.002), however the rate was 100% for short stenosis (A and B lesions <5 cm TASC classification) in both groups; in contrast to 93% for Group I versus 46% for Group II for longer stenoses (C and D lesions, p=0.0003). The late clinical success rate was superior for the longer lesions in Group I: 84% versus 46% (p=0.007). Primary patency rates at 1, 2, 3, and 5 years were comparable in both groups for shorter lesions: 100%, 98%, 98%, and 87% for Group I versus 100%, 93%, 85%, and 85% for Group II (p=0.1318), but were superior for Group I in longer lesions: 100%, 90%, and 72% versus 46%, 46%, and 28% for Group II (p<0.0001).
Conclusions: Primary stenting should be offered to all TASC C and D lesions.