One-Year ETAP Data Compare Endovascular Treatments in the Popliteal Artery

June 25, 2013—In Circulation, Aljoscha Rastan, MD, et al published findings from the prospective, multicenter randomized ETAP (Endovascular Treatment of Popliteal Artery) trial comparing stent placement versus percutaneous transluminal angioplasty (PTA) for the treatment of obstructive lesions of the popliteal artery (2013;127:2535–2541).

According to the investigators, the background of the study is that stenting has been shown to improve patency after femoral artery revascularization compared with PTA; however, limited data are available that evaluate endovascular treatment for obstructive lesions of the popliteal artery.

As summarized in Circulation, the ETAP trial compared primary nitinol stent placement to PTA in patients with peripheral artery disease (Rutherford-Becker class 2–5), who had a de novo lesion in the popliteal artery. The primary study endpoint was 1-year primary patency, defined as freedom from target lesion restenosis (luminal narrowing ≥ 50%) as detected by duplex ultrasound. Secondary endpoints included the target lesion revascularization rate and changes in Rutherford-Becker class. Provisional stent placement was considered target lesion revascularization and loss of primary patency.

The trial was composed of 246 patients, with a mean target lesion length of 42.3 mm. At 1 year, 197 patients were available for follow-up.

The investigators reported that the 1-year primary patency rate was significantly higher in the group with primary nitinol stent placement (67.4%) than in the PTA group (44.9%; P = .002). Target lesion revascularization rates were 14.7% and 44.1%, respectively (P = .0001); however, when provisional nitinol stent placement was not considered target lesion revascularization and loss of patency, no significant differences prevailed between the study groups (67.4% vs 65.7%; P = .92 for primary patency). Approximately 73% of patients in the PTA group and 77% in the nitinol stent group showed an improvement of ≥ 1 in Rutherford-Becker class (P = .31).

From the ETAP data, the investigators concluded that primary nitinol stent placement for obstructive lesions of the popliteal artery achieves superior acute technical success and higher 1-year primary patency only if provisional stenting is considered target lesion revascularization. Provisional stenting as part of a PTA strategy has equivalent 1-year patency and should be preferred over primary stenting, stated the investigators in Circulation.