The Advanta V12 stent (MAQUET) is the company’s proprietary balloon-expandable covered stent technology. Prof. Richard G McWilliams, Radiology Department, Royal Liverpool University Hospital, Liverpool, UK, spoke about his centre’s experience with the Advanta V12.
McWilliams said, at his unit, the in-patient centre in an arterial network in the UK National Health Service (NHS) which has a “long history of recognised excellence in vascular surgery and intervention”, the Advanta V12 is used. There are 10 vascular surgeons and seven full-time, consultant interventional radiologists at the centre.
“We were the first centre in the UK to start using fenestrated grafts. At the beginning we often used uncovered stents, depending on the amount of infrarenal neck in the FEVAR cases, but as we progressed to shorter and shorter necks, we needed more often to use a covered stent. When the Advanta V12 came out we started using it early in our experience and we now use it routinely.”
There are a wide range of applications for the Advanta V12 stent, including FEVAR. “Because our experience has been so good we extrapolated this and have had the confidence to use the Advanta V12 at other sites where we had traditionally used uncovered stents” comments McWilliams.
Other indications include: supra-aortic branches (such as the subclavian artery) and common carotid ostial lesions and mesenteric ischaemia for coeliac access and SMA stenotic disease. In response to Prof. Oderich’s study in which the primary patency at 36 months for covered vs. bare metal for chronic mesenteric ischaemia for the primary intervention arm was 92% vs. 52%, McWilliams says it supports their empirical decision to use the stent with good evidence.
The Advanta V12 RX system is also applicable in other visceral arteries such as renal artery stenosis and renal artery aneurysms if stenting is used rather than liquid embolics and hepatic artery pseudoaneurysms. McWilliams says, at his unit, the Advanta V12 has also been employed in aortic trauma and aortic stenosis and in CERAB (Covered Endovascular Reconstruction of Aortic Bifurcation) procedures treating aortoiliac occlusive disease.
McWilliams notes that they are very pleased with the CERAB technique with the three stent approach with one placed in the aorta and two in the common iliacs to create a new aortoiliac bifurcation. He says they are very happy to do this percutaneously. Usman Shaikh is the lead for CERAB at Royal Liverpool University Hospital.
He says the benefits of using the Advanta V12 are that there is a good range of sizes to fit different anatomies, it is covered inside and outside which avoids snagging of J-tip guidewires and makes repeat access uncomplicated and, in a post-dilation setting, it can be flared at the level of the fenestration to lock it and facilitate subsequent access. He notes that restenosis and occlusion rates, at his unit, are very low.
“The best data on this is the COBEST (Covered vs. Bare Metal Stent) trial from Perth, Australia, which rounds things off nicely as Perth is the home of fenestrated grafting and that is where our initial driver for using the Advanta V12 for fenestrated came from. Further use of the stent is supported by the COBEST study,” noted McWilliams.
The COBEST study was published in the Journal of Vascular Surgery in 2011. It showed that covered stents performed best for TASC C and D aortoiliac lesions in long-term patency in clinical outcome.
McWilliams added to this saying that, from their clinical results using the Advanta V12 in FEVAR at 10 years, there were no recorded Advanta V12 stent occlusions.
“We are looking forward to some further data in the future on the Advanta V12 vs. Bare Metal Stents in the iliac system from ongoing studies. Our experience with the stent is very positive and combined with modern, flexible sheaths we are able to deliver this stent everywhere. We have no fears about reaching for an Advanta V12 stent.”