Tools of the Trade
Key metrics include radial strength, flexibility, trackability, fatigue resistance, and foreshortening
Can be self-expanding vs balloon-expandable; bare metal vs drug eluting vs covered vs biodegradable; open vs closed cell
Generally, balloon-expandable is superior for precise placement, e.g., renal artery stenting, whereas self expanding tends to have better radial force
Covered stents help prevent ingrowth (e.g. malignant biliary obstruction) and better excludes things like bleeding
Drug-eluting stents may provide some patency advantage. There was controversial data suggesting increased mortality with PAD interventions. This has since been debunked but some people remain reluctant
Biodegradable stents are promising theoretically but have had inferior patency rates
Bare Metal - Balloon Expandable:
Palmaz (Cordis)
XD - Flexible and large
Bare Metal - Self Expanding:
Venous Stents
Venovo (BD)
Abre (Medtronic)
Zilver Vena (Cook)
Viafort (Gore) - still in investigational status
Zilver (Cook) - also has paclitaxel eluting version (Zilver PTX)
SMART (Cordis)
Protege (Medtronic)
Misago (Terumo)
Luminexx (BD) - 6F sheath, not flexible
Wallstent (Boston Scientific)
Acculink (Abbott)
Supera (Abbott) - Very flexible, good for areas that get a lot of movement (like popliteal), but difficult to deploy
Covered Stent Graft - Balloon Expandable
iCAST (Getinge)
VBX (Gore) - stands for “Viabahn Balloon Expandable”
LifeStream (BD)
Papyrus (Biotronik) - very expensive small covered stent (up to 5 mm) intended for the coronary system but reports of successful use in small visceral arteries off-label, e.g., hepatic artery transplant stenosis
Covered Stent Graft - Self Expanding
Viabahn (Gore) - has 0.018” and 0.035” devices
Wallgraft (Boston Scientific) - versatile but prone to foreshortening up to 20-50%
Niche Stents