Incidence of stent fractures and patency after femoropopliteal stenting with the nitinol self-expandable SMART stent: A single-center study

OBJECTIVE: The aim of the study was to investigate long-term incidence of stent fractures and patency after femoropopliteal stenting. METHODS: Sixty consecutive patients (mean age 70 ± 7 years) were treated with implantation of single (31 patients) or multiple (29 patients) self-expandable nitinol SMART stents (Cordis, Miami, Florida, USA; mean stent length 108.8 ± 73 mm) between year 2000 and 2005. At a mean follow-up of 66 ± 20 months, 37 patients (85% men, mean age 71 ± 7 years) were alive and underwent plain radiograph and color-coded duplex sonography. A peak systolic velocity was measured proximally, intrastent and distally. RESULTS: Stent fractures were detected by radiograph in three of the 39 (7.7%) legs (mean stented segment 207 ± 64 mm). In one case, a moderate strut fracture was associated with in-stent occlusive restenosis confirmed by angiography. Color-coded duplex sonography revealed a mean in-lesion peak systolic velocity of 73 ± 35 cm/s, six (15%) in-stent restenoses and four (11%) total occlusions. Primary patency rate 5 years after nitinol SMART stent implantation was 74.6%. Patients symptomatic for claudication or presenting with diagnosis of in-stent restenosis underwent angiography. CONCLUSION: Long-term femoral SMART stenting showed minimal incidence of fractures compared with previously published data with different stent types. In-stent restenosis and occlusive restenosis seem to be correlated with stented segment length.