Recent advances in self-expanding stents for use in the superficial femoral and popliteal arteries

Abstract

Significant advances have been made in femoropopliteal stent design and clinical outcomes during the past decade. Initial randomized studies demonstrated superiority of nitinol self-expanding stents to balloon angioplasty for treatment of moderate-length superficial femoral artery stenoses. During longer-term follow-up, first generation nitinol stents were hampered by high rates of stent fracture. A number of newer nitinol stent designs have been developed with improved conformability, greater radial strength and lower rates of long-term stent fracture. These newer stent designs have demonstrated superior primary patency and decreased restenosis for the treatment of moderate-length femoropopliteal lesions relative to historical benchmarks. Recent advances in drug-eluting nitinol stents have also offered treatment options for challenging lesion subsets including very long femoropopliteal lesions and for the treatment of in-stent restenosis. This article reviews recent advances and upcoming research in nitinol self-expanding stent technology for the treatment of superficial femoral and popliteal artery stenosis.

Keywords::

• claudication
• nitinol stents
• peripheral artery disease
• popliteal artery
• randomized trials
• restenosis
• stent
• superficial femoral artery

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Peripheral arterial disease affects an increasing number of patients worldwide.

• Atherosclerotic disease of the superficial femoral artery and popliteal arteries are common culprits in such patients.

• While a variety of endovascular treatment options are available for treatment of femoropopliteal disease, stenting is increasingly common as stent patency improves with newer generation stents. Stents also have an important role as bailout treatment after suboptimal balloon angioplasty.

• Randomized trials have shown the superiority of stenting to balloon angioplasty for femoropopliteal lesions longer than 40 mm.

• Currently, several US FDA-approved nitinol self-expanding stents are available for use in the femoropopliteal artery.

• The FDA-approved Zilver PTX drug-eluting nitinol self-expanding stent has shown favorable results in the femoropopliteal segment.

• The Viabahn covered stent graft is reasonable option for treatment of long lesions in the superficial femoral artery.

• Ultimately, restenosis rates remain high for stenting of the femoropopliteal artery, especially for lesions exceeding 150 mm in length. Further advances are needed to provide optimal treatment for this patient population.