Relative No - Stent Zones in the Femoropopliteal Arteries

A s endovascular therapy has revolutionized the treatment of lower extremity peripheral arterial disease (PAD) over the past decade, no single therapy has emerged as the clear gold standard. Acceptance of endovascular therapy has been quick among practitioners, but there remains question about which technology is best and most durable in any particular vascular bed. As techniques and technology have evolved, most vascular specialists have recognized there is no single best treatment option that can be generalized to all patient populations, and many patient and lesion variables play a role in choosing any particular technology. For more than a decade, there has been a paucity of outcomes data, especially in the infrainguinal arterial bed. Only recently has any technology been proven superior to balloon angioplasty in the superficial femoral artery (SFA). Stents and stent grafts have emerged as two of the technologies that may promote more durable patency, especially in the SFA. These nickel titanium (nitinol) alloy stents and polytetrafluoroethylene (PTFE)-covered stent grafts have allowed for the treatment of even complex obstructive lesions in the lower extremity arteries. Newer stent designs are providing increased durability, flexibility, and radial force. Several small, single-center and multicenter reports have demonstrated the efficacy of nitinol stents in the femoropopliteal arteries.1 More recently, a prospective, randomized trial comparing balloon angioplasty to a nitinol stent has been published, showing improved primary patency as well as increased absolute claudication distance at 1 year.2 The RESILIENT trial results have been presented and have also demonstrated the superiority of nitinol stents over balloon angioplasty, leading to the first US Food and Drug Administration approval of a nitinol tube-based stent for use in the SFA. Stent grafts have also demonstrated superiority to balloon angioplasty in a multicenter study.3 A randomized, multicenter study (VIBRANT) comparing nitinol stents and stent grafts in long lesions has recently been completed; these results will be released in the latter part of 2009. Although stents have been shown to be efficacious, multicenter data from the first evaluation of a drug-eluting nitinol stent platform compared to a bare-metal stent noted an occurrence of stent fracture.4 In this mulRelative No-Stent Zones in the Femoropopliteal Arteries