R E V I E W Drug-eluting stents in the management of peripheral arterial disease Marc Bosiers1 Catherine Cagiannos1 Koen Deloose1 Jürgen Verbist2 Patrick Peeters2 1Department of Vascular Surgery, AZ St-Blasius, Dendermonde, Belgium; 2Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium Correspondence: Marc Bosiers Department of Vascular Surgery, AZ St-Blasius, Kroonveldlaan 50, 9200 Dendermonde, Belgium Tel + 32 5225 28 22 Fax + 32 5225 22 89 Email marc.bosiers@telenet.be Abstract: Since major meta-analyses of randomized controlled trials in interventional cardiology showed the potential of drug-eluting stents in decreasing restenosis and reintervention rates after coronary artery stenting, one of the next steps in the treatment of arterial occlusive disease is the transfer of the active coating technology towards peripheral arterial interventions. In this manuscript, we aim to provide a literature overview on available peripheral (lower limb, renal, and supra-aortic) drug-eluting stent applications, debate the cost implications, and give recommendations for future treatment strategies. Keywords: critical limb ischemia, drug-eluting stent, below the knee, infrapopliteal, crural, limb salvage Endovascular interventional techniques have been used to treat peripheral arterial occlusive disease (PAOD) since their conception and, despite many improvements, they remain the subject of continued modiﬁcations. Although percutaneous transluminal angioplasty (PTA) and stenting are now widely accepted and are even gradually replac- ing traditional open peripheral vascular surgical approaches, there remains one sig- niﬁcant limiting factor: post-angioplasty and in-stent restenosis. Major meta-analyses of randomized controlled trials (RCT) from interventional cardiology show that in coronary artery disease, the use of drug-eluting stents (DES) has resulted in decreased restenosis and reintervention rates compared to bare metal stents (BMS) (Hill et al 2004; Mauri et al 2005; Roiron et al 2006). There is heterogeneity between outcomes depending on different drug coatings (sirolimus and its derivates versus paclitaxel and its derivates), suggesting higher efﬁcacy with sirolimus-eluting stents. This manuscript reviews the literature for the available applications of DES in the management of PAOD and presents recommendations for future treatment strategies. Methods We reviewed publications listed in MEDLINE that presented applications of DES in noncoronary arterial disease from 1950 up to March 2007. The key word searched was “stent” combined with terms describing stent coating, “eluting, paclitaxel, sirolimus”, and lesion location, “peripheral, infrapopliteal, below-the-knee, crural, femoral, iliac, renal, carotid, intravascular, extravascular”. In addition, relevant abstracts and presentations from pertinent conferences (TCT, CIRSE, Charing Cross and Euro-PCR) were identiﬁed and the reference sections of retrieved articles were manually screened. Furthermore, ongoing unpublished trials were identiﬁed by accessing www.clinicaltrials.gov. Results Drug-eluting stents have been used to ameliorate outcomes in the treatment of ath- erosclerotic occlusive disease in various noncoronary locations. We believe that DES Vascular Health and Risk Management 2008:4(3) 553–559 © 2008 Dove Medical Press Limited. All rights reserved 553