***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE To assess 3- and 12-month angiographic restenosis rates and their clinical impact after  infrapopliteal angioplasty .  DESIGN Prospect i ve multicenter study . MATERIAL S AND METHODS We analyzed 68 critical ischemic limbs ( tissue loss : 58 limbs ) from 63 consecutive patients due to isolated infrapopliteal lesions who underwent angioplasty alone .  Primary endpoint was 3-month angiographic restenosis rate ; secondary endpoints were 12-month angiographic restenosis rate , and 3- and 12-month rates of mortality , major amputation and reintervention . Three- and 12-month frequency of ambulatory status and of freedom from ischemic symptoms , and time to wound healing in the ischemic wound group , were compared between restenotic and non-restenotic groups . Angiographic restenosis predictors were assessed by multivariable analysis . RESULTS 95 % of cases had 3-month angiography ; restenosis rate was 73 % : 40 % restenosis and 33 % re-occlusion . Twelve-month follow-up angiography was conducted for the patients without 3-month angiographic restenosis , and restenosis rate at 12 months was 82 % . Non-administration of cilostazol and statin , and chronic total occlusion were 3-month angiographic restenosis predictors . Three- and 12-month mortality was 5 % and 12 % , respectively . Despite no patients having undergone amputation , 15 % had persistent ischemic symptoms , and 48 % of limbs underwent reintervention within 12 months . During the same study period , ambulatory status and limbs with complete healing were more frequently observed in the non-restenosis group than in the restenosis group . In the tissue loss group , time to wound healing in the restenosis group was longer than in the non-restenosis group ( 127 days vs. 66 days , p = 0.02 ) . CONCLUSION The extremely high angiographic restenosis rate after infrapopliteal angioplasty may adversely impact clinical status improvement Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES The study investigated the efficacy and safety of a balloon exp and able , sirolimus-eluting stent ( SES ) in patients with symptomatic infrapopliteal arterial disease . BACKGROUND Results of infrapopliteal interventions using balloon angioplasty and /or bare stents are limited by a relatively high restenosis rate , which could be potentially improved by stabilizing the lesion with a SES . METHODS Two hundred patients ( total lesion length 27 ± 21 mm ) were r and omized to infrapopliteal SES stenting or percutaneous transluminal balloon angioplasty ( PTA ) . The primary endpoint was 1-year in-segment binary restenosis by quantitative angiography . RESULTS Ninety-nine and 101 patients ( mean age 73.4 years ; 64 % diabetics ) were r and omized to SES and PTA , respectively ( 8 crossover bailout cases to SES ) . At 1 year , there were lower angiographic restenosis rates ( 22.4 % vs. 41.9 % , p = 0.019 ) , greater vessel patency ( 75.0 % vs. 57.1 % , p = 0.025 ) , and similar death , repeat revascularization , index-limb amputation rates , and proportions of patients with improved Rutherford class for SES versus PTA . CONCLUSIONS SES implantation may offer a promising therapeutic alternative to PTA for treatment of infrapopliteal peripheral arterial disease Purpose : To report the 6-month angiographic results from a prospect i ve single-center study investigating the efficacy and outcome of sirolimus-eluting stents used for bailout after infrapopliteal revascularization of patients with critical limb ischemia ( CLI ) . Methods : Twenty-nine patients ( 21 men ; mean age 68.7 years ) underwent infrapopliteal revascularization with bare metal stents ( group B ) implanted for bailout in 65 lesions ( 38 stenoses and 27 occlusions ) in 40 infrapopliteal arteries . Another 29 patients ( 21 men ; mean age 68.8 years ) underwent infrapopliteal bailout stenting with sirolimus-eluting stents ( group S ) in 66 lesions ( 46 stenoses and 20 occlusions ) in 41 vessels . Preliminary 6-month angiographic and clinical results were analyzed . Results : Hyperlipidemia and symptomatic cardiac and carotid diseases were more pronounced in group S ( p < 0.05 ) . Technical success was 96.6 % ( 28/29 limbs ) in group B versus 100.0 % in group S ( p=0.16 ) . Six-month primary patency was 68.1 % in group B versus 92.0 % in group S ( p < 0.002 ) . Binary in-stent and in-segment restenosis rates were 55.3 % and 66.0 % , respectively , in patients with bare stents versus 4.0 % and 32.0 % , respectively , in patients treated with the sirolimus-eluting stents ( both p < 0.001 ) . The target lesion reintervention rate at 6 months was 17.0 % in group B versus 4.0 % in group S ( p=0.02 ) . Limb salvage was 100 % in both groups . Six-month mortality and minor amputation rates were 6.9 % and 17.2 % , respectively , in group B versus 10.3 % and 3.4 % , respectively , in group S ( p=0.32 and p=0.04 , respectively ) . Conclusions : Sirolimus-eluting stents seem to restrict neointimal hyperplasia in the infrapopliteal vascular bed PURPOSE To determine the clinical outcome and the success of stent application for high- grade lesions of the infrapopliteal arteries compared with treatment with percutaneous transluminal angioplasty ( PTA ) in critical limb ischemia ( CLI ) . MATERIAL S AND METHODS In this ethics board-approved r and omized prospect i ve study ,  PTA or stent application was performed on 131 lesions in 88 patients with CLI . The primary end points were clinical improvement after endovascular treatment and limb salvage rate . Secondary end points were defined by the minimal lumen diameter ( MLD ) before and after the revascularization procedure , percentage of residual diameter stenosis ( DS ) , binary restenosis rate ( > 50 % DS and > 70 % DS ) , and incidence of target lesion revascularization at 9-month follow-up . RESULTS At 3 months , the clinical status in the PTA group was less improved than that in the stent group ( P = .008 ) . At 9 months , there had been five minor and two major amputations in the PTA group and five major and five minor amputations in the stent group . MLD was significantly larger and the percentage of DS was significantly less in the stent group at completion angiography . At 9 months , the angiographic control showed better trends for the stent group in comparison to the PTA group despite that no significant differences were detected ( MLD , 1.19 mm ± 0.92 vs 1.02 mm ± 1.02 ; DS , 38.68 % ± 25.47 vs 43.31 % ± 28.37 ) . CONCLUSION Infrapopliteal stent application is an effective treatment modality in CLI . The PTA and stent groups were essentially equal at 3 and 9 months except for the difference in clinical improvement in the stent group at 3 months OBJECTIVES We investigated the efficacy and safety of using balloon exp and able drug-eluting stents ( DES ) to prevent amputations in patients with below-the-knee critical limb ischemia . BACKGROUND Critical limb ischemia patients have a 1-year amputation rate of 30 % and a mortality rate of 25 % . Most patients with critical limb ischemia have severe below-the-knee arterial disease that limits the use of bypass surgery or balloon angioplasty . METHODS In all , 106 patients ( 118 limbs ) were treated with DES  in this prospect i ve , nonr and omized trial . No patients were excluded because of comorbidities or unfavorable anatomy . Primary end points were major amputation and mortality , each stratified by Rutherford category . RESULTS The mean patient age was 74 + /- 9 years . There were 228  DES implanted ( 83 % Cypher [ Cordis , Johnson & Johnson , Warren , New Jersey ] , 17 % Taxus [ Boston Scientific , Maple Grove , Minnesota ] ) . The number of stents per limb was 1.9 + /- 0.9 , and 35 % of limbs received overlapping DES ( length of 60 + /- 13 mm ) . There were no procedural deaths , and 96 % of patients were discharged within 24 h. The 3-year cumulative incidence of amputation was 6 + /- 2 % , survival was 71 + /- 5 % , and amputation-free-survival was 68 + /- 5 % . Only 12 % of patients who died had a preceding major amputation . Rutherford category , age , creatinine level , and dialysis ( p < or= 0.001 to 0.04 ) were predictors of death but not amputation . Target limb revascularization occurred in 15 % of patients , and repeat angiography in 35 % of patients revealed a binary restenosis in 12 % . CONCLUSIONS Treating below-the-knee critical limb ischemia with DES is an effective and safe means of preventing major amputation and relieving symptoms . Procedural complications and limb revascularization rates were low . Limb salvage and survival rates in patients treated with DES exceed those of historic controls 
    Output:
    
Conclusion DES for focal infrapopliteal lesions significantly inhibit vascular restenosis and thereby improve primary patency , decrease repeat procedures , improve wound healing , and prolong overall event-free survival