Évolution des stents pour le traitement des lésions de l'artère fémorale superficielle

Endovascular treatment and stent implantation in the superficial femoral artery have been proposed for over 20 years. However, the first experiments with stainless stents were relatively disappointing. The first improvement consisted in the introduction of nitinol self-expanding stents. This technology allowed an initial improvement of clinical performances, but the first generation of nitinol stents demonstrated a relatively high rate of fractures. Better knowledge of the femoral artery biomechanics and advances in technology allowed to propose a second generation of nitinol stents with improved flexibility, which decreased the rates of fracture. In-stent restenosis related to neointimal hyperplasia has also led to the development of new concepts to improve patency rates after stenting of the femoral artery: drug-eluting stents (coated-stents), biodegradable stents, and covered stents. These technologies will help to treat more complex lesions of the femoral artery in the future, with comparable results to those obtained with femoropopliteal bypasses, but we are still waiting for results of ongoing studies.