Patients with chronic mesenteric ischemia are better off with a stent that has a plastic outer layer than with a bare metal stent. This is evident from research by Luke Terlouw (Erasmus MC) and others, published in The Lancet Gastroenterology & Hepatology. The plastic covering on the stent prevents the wall of the blood vessel from growing into the stent and causing a new narrowing.
Chronic mesenteric ischemia is not easy to diagnose. Symptoms – such as postprandial abdominal pain, food anxiety and weight loss – can vary widely between patients. The treatment has improved considerably in recent decades. Although some patients will still benefit from open surgical reconstruction, most patients are successfully treated with endovascular techniques. Retrospective research has shown that reoperations are often necessary, especially in patients treated with bare, metal stents.
Terlouw et al. decided to investigate the latter in a randomized trial. 94 patients with chronic gastrointestinal ischemia participated in this trial. Half received a metal stent and the other half a stent with a plastic covering. The researchers compared the outcomes 6 months, 12 months and 24 months after the procedure. The difference was clear: with the metal stent the blood vessel became seriously narrowed again after 2 years in more than half of the people, while with the covered stent this was the case in less than one in five people.
Two commentators, Bernardo Mendes and Randall DeMartino, qualify the results of the trial as ‘a big step forward’. It is now clear: covered stents are better. But they add that “the ideal surveillance regimen, the impact of restenosis, and the clear role of statins in outcomes remain to be determined.” And that open surgery for complex lesions or for lesions for which endovascular treatment was unsuccessful will continue to be necessary.
In an explanation to the press, the researchers have now announced that the guidelines will be adjusted ‘after consultation with the national working group’.