Related Experiment Video
Updated: Apr 20, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Evidence for the use of drug eluting stents in below-the-knee lesions
D Trombert1, C Caradu, V Brizzi
1Unit of Vascular Surgery, Hopital Pellegrin Universitary Hospital of Bordeaux University of Bordeaux, Bordeaux, France - eric.ducasse@chu-bordeaux.fr.
Insights
Drug-eluting stents (DES) show promise for treating below-the-knee (BTK) peripheral arterial disease in critical limb ischemia (CLI) patients. While improving angiographic outcomes, further clinical data is needed to confirm their long-term efficacy and safety.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Biomaterials in Medicine
Background:
- Peripheral arterial disease (PAD), particularly below-the-knee (BTK) arteriopathy, is increasingly prevalent, especially in diabetic patients.
- Critical limb ischemia (CLI) presents significant morbidity and mortality, with high rates of amputation, mortality, and chronic pain.
- Endovascular treatment is often the primary approach for CLI due to patient comorbidities.
Purpose of the Study:
- To review the literature over the last 15 years on the use of drug-eluting stents (DES) for BTK revascularization.
- To evaluate the efficacy and safety of DES compared to other treatment modalities in BTK lesions.
- To identify current limitations and future research needs regarding DES in BTK interventions.
Main Methods:
- Extensive literature review of studies published in the last 15 years.
- Analysis of trials comparing DES to balloon angioplasty, bare metal stents (BMS), and drug-eluting balloons.
- Inclusion of studies comparing different drug-eluting agents (paclitaxel vs. sirolimus).
Main Results:
- DES demonstrate improved angiographic results compared to BMS, including better primary patency and reduced restenosis and target lesion revascularization (TLR) rates.
- Studies indicate DES are a potential solution for BTK arteriopathy in CLI patients.
- Limitations include a lack of robust clinical outcome data and a focus on short lesions.
Conclusions:
- DES offer improved angiographic outcomes in BTK revascularization for CLI patients compared to BMS.
- Concerns remain regarding the mechanical properties of DES (metal stents) and their potential for complications like compression and fracture, which can increase restenosis.
- Further clinical studies are essential to fully establish the role and long-term effectiveness of DES in BTK interventions.
Abstract:
Peripheral arterial disease has become more and more present in daily practice, mostly due to the increase of cardiovascular risk factors, especially in below the knee (BTK) area in diabetic patients. Critical limb ischemia (CLI) is the most usual clinical presentation with a major amputation rate of 30%, mortality rate of 25%, and chronic pain of 20% at one year. Nowadays, endovascular treatment is usually the first choice, given the high comorbidity of those patients. Angioplasty and stenting in BTK lesions have already proven their efficacy in CLI treatment. However, BTK revascularization remains highly controversial in the treatment of intermittent claudication in TASC 2 recommendations. Restenosis being the major pitfall in BTK procedures, the use of drug-coated devices is one of the actual answers. We performed an extensive review of the literature over the last 15 years on the use of drug-eluting stents (DES) in BTK revascularization. DES has been compared to balloon angioplasty, in the ACHILLES trial, bare metal stents (BMS), in the DESTINY and YUKON trials, drug eluting balloons, in a trial guided by Siablis, and paclitaxel has even been compared to sirolimus in the PARADISE trial. In conclusion, DES is one of the solutions to the increase of BTK arteriopathy in CLI patients. Angiographic results are better, compared to BMS, in terms of primary patency, restenosis and TLR rates. However clinical results are missing. Treated lesions in the literature are short lesions. And DES is a metal balloon expandable stent with greater risks of compressions and stent fractures than nitinol self expandable stents, and such complications are known to increase post operative restenosis rates. Further reports are still needed on this matter.
