Use of Coronary Covered Stents for Mesenteric Artery Revasculatization
2Cardiac Imaging Unit, Sheba Medical Center
3Interventional Radiology Unit, Sheba Medical Center
4Interventional Radiology Unit, Cleveland Clinic, USA
Background:
Chronic mesenteric ischemia (CMI) is a condition caused by mesenteric arterial artery stenoses (MAS), the main etiology being atherosclerotic disease. Endovascular revascularization is the preferred approach. The visceral vasculature is characterized by small-caliber, tortuous vessels for which coronary covered stents (CCS ) provide an appealing alternative to standard peripheral stents due to their low-profile design and flexibility.
Methods: This single-center retrospective study included adults who underwent endovascular revascularization of the mesenteric arteries with Bentley BeGraft coronary covered stents (Bentley InnoMed GmbH, Hechingen, Germany) between October 2020 and August 2025. Exclusion criteria were acute indications, prior stenting and use of non-coronary stents. Primary endpoint was clinically relevant restenosis or occlusion. Secondary endpoints included technical and procedural success, radiographic restenosis, complications, and clinical response.
Results: Nineteen patients underwent 20 procedures, treating 26 arteries (Celiac 9/26, Superior mesenteric artery 14/26, Inferior mesenteric artery 3/26). Indications included symptomatic CMI (16/20, 80%) and pre-EVAR branch preparation (4/20, 20%). Technical success was achieved in 19/20 procedures (95%), and procedural success was 100%. Radiologic in-stent stenosis or occlusion at any point was observed in 18/26 treated arteries (69%), but only 4/26 (15%) were clinically relevant and underwent reintervention. Most cases of stenosis (12/16, 75%) were detected on the first post-procedural duplex US with no clinical significance. Primary patency was 90% (18/20) and 93% (14/15) at 6 months and 12 months, respectively. Overall patency at last imaging follow-up (median 351 days) was 83%. Symptomatic improvement was observed following 16/20 procedures (80%). Post-procedural complications occurred in 2/20 (10%) procedures.
Conclusions: Revascularization of chronic atherosclerotic MAS using CCS demonstrated high procedural success and acceptable clinically driven patency. Early radiologic restenosis did not necessarily correspond to clinical failure. Prospective studies with standardized follow up are needed to better define durability and clinical benefit.