Stent fracture after provisional stenting using four brands of nitinol stents in trans-atlantic inter-society consensus c and d femoropopliteal lesions: in 1 year’s follow-up

Introduction
Stenting Trans-Atlantic Inter-Society Consensus C and D lesions of the femoral–popliteal segment is still controversial. There is a wide range of stent fractures ranging between 2 and 62% with different clinical outcomes. This study aimed to investigate the clinical impact and outcome of stent fracture of complex lesions of the femoral–popliteal territory using four brands of stents after 1 year.
Patient and methods
This was a retrospective study on 102 limbs that had Trans-Atlantic Inter-Society Consensus C and D femoral–popliteal lesions. All of them were treated with balloon angioplasty with bailout stenting (self-expandable nitinol stents, Portege EverFlex, E-Luminexx, and Absolute Pro). Patients were followed up by clinical assessment, and duplex and biplane radiography to detect stent fracture.
Results
After a mean 9±5.6 months’ complete follow-up of 150 stents in 102 limbs, mean length of the stented segment being 16.5±9.9 cm, the following results were obtained. An overall 78% of stents were fractured. An overall 88.2% of the treated limbs were occluded and presented with critical limb ischemia. The patency rate was 0% for type III and type IV stent fractures, 50% for type II stent fracture, and 6.25% for type I stent fracture. There was no correlation between the type of stent fracture and either stent location (proximal, mid, distal superficial femoral artery and supragenicular popliteal artery) or stent design (brand).
Conclusion
The patency rate for the stented femoral–popliteal segment was very poor, despite great advances in the designs of stents to withstand the highly varied forces applied to this segment. Stenting this segment should be the last option, in which surgery has a great risk (drug-coated balloon and/or atherectomy devices, failed or unavailable).