Acute limb ischaemia from stent thrombosis: bad luck or bad protoplasm?

Acute limb ischaemia (ALI) is a vascular emergency resulting from the acute occlusion of a major artery of the extremities. The range of aetiologies includes in situ thrombosis – often due to restenosis after prior intervention with a balloon/stent/stent graft (SG) – an athero- or cardioembolic event, arterial dissection, or trauma. During the height of the COVID-19 pandemic, inflammatory thrombophilia in the setting of coronavirus infection was also common and increased the incidence of ALI1. The clinical presentation of ALI may range from pallor, rest pain, poikilothermia with loss of motor and/or sensory function all the way to frank necrosis depending upon the time from symptom onset to presentation and the presence of collateral blood supply.

In patients with symptomatic femoropopliteal (FP) peripheral arterial disease (PAD), endovascular intervention is the dominant modality for revascularisation therapy2, with balloon angioplasty serving as the single most common therapy. Primary stenting as first-line therapy is elected much less commonly; however, “bailout” stenting such as in cases of flow-limiting dissection, inadequate luminal gain due to calcification, recoil or perforation is common. Stenting in the...