Endovascular management of unilateral common iliac artery ostial occlusive disease; bilateral kissing stents, unilateral stent with contralateral supporting balloon or unilateral stent with contralateral safety wire; comparative study

Aim
To evaluate the safety, early, and short-term efficacy of kissing stents, unilateral common iliac artery (CIA) stent with contralateral supporting balloon, and unilateral CIA stent with contralateral safety wire in patients with symptomatic unilateral CIA ostial occlusive disease.
Patients and methods
This prospective study was carried out from April 2016 to November 2019 at 6 October Insurance Hospital, Cairo, and Sohag University Hospitals on 79 patients complaining of de novo unilateral CIA ostial occlusive disease, Rutherford category 3, 4, and 5, who were divided randomly into three groups to be treated endovascularly by bilateral kissing stent technique (group A), unilateral CIA stent in affected side associated with supporting balloon in the contralateral CIA (group B), or unilateral CIA stent in affected side associated with a safety wire in the contralateral CIA (group C). Patients were scheduled to be evaluated and followed up for 1 year.
Results
Technical success rate was 100, 87, and 67.9 in groups A, B, and C, respectively (=0.006). One-year primary patency rate was 91.7, 90.9, and 87.5% in groups A, B, and C, respectively (=0.998). A total of seven (9.3%) patients developed significant stenosis. Of the seven patients, and three continued medically, as they were claudicant; three cases were treated by drug-coated balloon angioplasty, and one patient by aortofemoral bypass. Plaque shift incidence was 4.3 and 14.3% in groups B and C, respectively (=0.095). Distal embolization occurred in the contralateral side in 8.7 and 17.9% in groups B and C, respectively (=0.083).
Conclusion
Kissing stent technique for treatment of unilateral ostial CIA occlusive disease achieves excellent technical success with minimal early and short-term procedure-related complications compared with unilateral stent with contralateral supporting balloon or unilateral stent with contralateral safety wire.