Which stent for which lesion in peripheral interventions?

Applications of endovascular procedures have been expanded dramatically thr oughout the human body for both occlusive and aneurysmal disease; arteries at the aortoiliac and femoropopliteal levels are no exception. Currently, i nterventional procedures are the 1st treatment option for most patients who have peripheral artery disease. Although balloon angioplasty alone offers good immediate and long-term results, the addition of stents has been propo sed to improve the procedural success of angioplasty and extend its applica tion to more patients with vascular disease. Stenting, however, is controve rsial. Its use is considered acceptable in the aortoiliac vessels but is mo re in dispute for the femoropopliteal vessels. Moreover, the rapid developm ent of endovascular stents for peripheral applications has made stent selec tion a complicated task for clinical practitioners. Many factors influence the type of stent selected; therefore, knowledge of the stents available-in cluding various designs and individual properties-is mandatory. Appropriate selection depends on adequate preprocedural evaluation of the lesion; the choice of approach; the choice of primary versus selective stent placement; the location and characteristics of the lesion; the availability of stents in the intervention suite; and the experience of the operator. Several stents are now available, but they are not equivalent; it is import ant to select the stent that is best suited to the lesion. On the basis of our experience using different types of stents, as well as our review of th e world medical literature, we summarize the proper ties of various stents and specific indications for their application. This report is intended for use as a practical guide to stent selection.