Self-Expandable Endoprostheses as an Adjunct to Balloon Angioplasty in the Treatment of Peripheral Arterial Lesions

Abstract

Since Charles Dotter first published his idea of percutaneous insertion of an intra-vascular endoprosthesis as an adjunct to balloon angioplasty in 1969 [3], numerous types of vascular stents have been described in the radiological literature, and some have already become a clinically important advanced technique in the treatment of vascular occlusive disease [7, 13, 19]. Active or passive expansion are employed as two different principles for increasing the diameter of the endoprosthesis once inserted into the vessel. Some stents are self-expanding using the memory effect of nitinol wire as those devices published by Cragg and Rabkin [5, 15]. Self-expanding endoprostheses utilizing the spring-coil characteristics of stainless steel wire have been described with the Gianturco-Wallace zig zag stent, the Maass spiral, and the Wallstent [10, 19, 22]. Other devices, such as the Palmaz device and the Strecker endoprosthesis, are passively expanded by a balloon [12, 20]. Clinical application of vascular stenting necessitates development of a safe delivery system which allows exact placement of the endoprosthesis used. These problems have been sufficiently overcome for the Wallstent, the Palmaz device, the Strecker endoprosthesis, and the Gianturco-Wallace stent.