Comparison of aortoiliac disease stenting patency using balloon-expandable, self-expanding, and covered stents

Peripheral arterial disease (PAD) is estimated to affect 6.5 million individuals in the United States. In one-third of cases, PAD is located in the iliac arteries. It has been postulated that covered stents may provide superior outcomes, including patency, compared with other stent types (including balloon-expandable and self-expanding); however, these conclusions have largely been based on a relatively small number of studies. Large studies examining patency rates in real-world populations are lacking. We investigated patency rates of balloon-expandable, self-expanding, and covered stents in PAD using an international database.

The Vascular Quality Initiative database was queried for all patients undergoing aortoiliac artery disease interventions with covered, balloon-expandable, or self-expanding stents between 2012 and 2017. Of the 7,517 patients identified, 5,631 were excluded for various reasons. Ultimately, 1,886 patients with a total of 2,673 lesions were included for analysis. Baseline demographic data and periprocedural variables were assessed. Primary patency rates were examined at 1 and 3 years.

The majority (58%) of stents implanted were balloon-expandable stents. The overall technical success rate was excellent in all three stent groups (>99%). One-year primary patency rates suggested a small benefit for balloon-expandable stents (98.4%) compared with self-expanding (97.1%) and covered stents (96.3%) (P = 0.03); however, this finding did not persist at 3 years (P = 0.17).

Contemporary real-world data suggest that there is no meaningful correlation between stent selection and 3-year primary patency in aortoiliac PAD interventions. Stent selection may be best guided by factors such as cost, lesion characteristics, and operator judgment, rather than long-term patency outcomes.