Dive Brief:

• The Society for Cardiovascular Angiography and Interventions, in conjunction with its virtual conference on Thursday, published guidelines covering the selection of devices for use in aorto-iliac arterial interventions.

• The authors found the most evidence to support the use of balloon-expandable covered stents and the least for specialty balloons and drug-eluting stents.

• SCAI published the guidelines the same day it established a position on the use of percutaneous coronary intervention (PCI) in patients with complex coronary artery disease and in ambulatory surgical centers. 

Dive Insight:

Physicians who want to use endovascular therapy to address blockages in patients with aorto-iliac disease can choose from a wide range of balloons and stents. However, while guidance on when to take an endovascular approach has emerged in recent years, there is a lack of evidence about the comparative effectiveness of different types of devices. The guidelines released Thursday are meant to address that gap.

In the guidelines, cardiologists present results of an analysis of randomized controlled trials and other studies of endovascular treatments of aorto-iliac disease. The analysis supported the creation of a chart showing the level of evidence for each type of device in the treatment of a range of lesions and occlusions.

The researchers identified balloon-expandable covered stents, such as BD’s LifeStream, as the most broadly effective type of device. In five of the 11 analyzed indications, the researchers found strong evidence to support the use of such stents. The evidence on the use of the stents in the other six indications was deemed to be moderate. 

Self-expanding and balloon-expandable bare-metal stents also fared reasonably well, with strong evidence to support their use in three indications and moderate evidence in a further six.

At the other end of the spectrum, the researchers found specialty balloons and drug-eluting stents provide no benefits in any of the indications. The researchers deemed drug-coated balloons to be almost as ineffective, finding no benefits in nine indications and only weak evidence to support their use in the other two. 

SCAI also published a position paper articulating its response to the CMS decision to reimburse PCI performed in ambulatory surgical centers. That decision, which SCAI supported, positioned physicians to perform PCI in lower-cost settings.

The group issued advice on the equipment and procedures that are needed to perform PCI outside of hospitals. The document also details how physicians can identify patients suitable for undergoing PCI at the centers. 

In another position statement, SCAI addressed the use of PCI in patients with complex coronary artery disease. The document covers the evidence on use of PCI in complex patients and advice on how to achieve the best outcomes in the population. 

Cardiologists also used the event to share the findings of their research. One paper analyzed data from a clinical trial primarily designed to show the effect of giving aspirin on top of AstraZeneca’s Brilinta to patients who had undergone successful PCI. The new secondary analysis found whether a patient received Boston Scientific’s bioabsorbable polymer stent Synergy or a durable polymer stent had no impact on outcomes.