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Online ISSN 1827-1847
Vykoukal D., Davies M. G.
Department of Cardiovascular Surgery, Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, TX, USA
Angioplasty and stents fail due to the development of intimal hyperplasia and material failures. The development of covered stents has been based on the creation of a barrier to intimal hyperplasia ingrowth by provision of a barrier to luminal ingrowth. Angioplasty is a controlled injury to the vessel wall. The injury leads to a healing response in the intima and media, which involves a program of cell apoptosis, cell migration, cell proliferation and extracellular matrix deposition. The intimal hyperplasic process in a stent is more prolonged and robust than in a balloon-injured artery and is proportional to the depth of injury that the recipient vessel sustains and the inflammatory response induced. The development of covered stents has been based on the creation of a barrier to intimal hyperplasia ingrowth by provision of a barrier to luminal ingrowth The “ideal indications” for stent grafting have been reported to be segments with a length of ≥1 cm proximal and distal without any obstruction, no lesions in the popliteal artery, at least one open tibial vessel and no severe calcifications. In patients with “optimal” conditions for implantation (no heavy calcifications, popliteal obstruction, or complete superficial femoral artery occlusion; minimum 1-vessel runoff; and adequate antiplatelet therapy or anticoagulation), the primary/secondary patency rates have been found to be 80/91% after the first year, 71/89% after 3 years, and 62/90% after 5 years.