Balloon angioplasty or nitinol stents for peripheral-artery disease

Schillinger et al. (May 4 issue)1 demonstrated the superiority of primary stenting with nitinol stents, as compared with balloon angioplasty, in patients with peripheral-artery disease. However, the findings raise an issue with regard to the treatment of restenosis. Endovascular treatment usually represents the second treatment option, after medical therapy and before final surgical revascularization. Restenosis of the target vessel after balloon angioplasty can be treated initially with repeated balloon angioplasty and, in subsequent recurrences, with stenting. In the meantime, the patient has months or years of freedom from symptoms without being treated with stents. In contrast, the reimplantation of a stent to treat restenosis after stenting is much more problematic, and the patient is more likely to require surgical revascularization. Patients with peripheral-artery disease should be offered therapeutic alternatives that will delay irreversible complications as long as possible. Even if balloon angioplasty is a less durable treatment option than nitinol stenting, we believe that it should be considered as the first step in the endovascular management of the disease.