The optimal treatment strategy for below-the-knee (BTK) peripheral artery disease (PAD) remains challenging due to the high incidence of restenosis and recoil after balloon angioplasty and stenting. Until now, the use of stent in these arterial segments was avoided because of the high occlusion rate and to preserve distal landing zones for potential bypass. Lately, bioresorbable scaffolds (BRS) have emerged as a promising alternative offering a temporary mechanical support while adhering to the ‘leave nothing behind’ philosophy.

The Magmaris stent (Biotronik, AG) is a magnesium scaffold designed to degrade completely within the human body within 12 months. This is a retrospective observational single center cohort study of all patients who underwent BTK Magmaris implantation between May 2023 and May 2024. First endpoint was target lesion revascularization (TLR) during follow-up. Secondary endpoints were death, technical success rate, and freedom from major amputation (MA).

18 patients were included in our study. There were 10 female (56%) and mean age was 78+/-9 years. Majority of the patients had diabetes (56%) and smoking history (50%). 5 (28%) had chronic renal insufficiency. Intervention was performed due to chronic limb ischemia in 11 patients (61%) : 1 had a Fontaine stage III and 10, a Fontaine stage IV; acute limb ischemia in 4 patients (22%): 1 had Rutherford stage I and 3 a Rutherford stage IIa; and anastomotic stenosis threatening the bypass in 3 patients (17%). BTK Magmaris implantation was performed due to dissection after angioplasty in 5 patients (28%) and residual stenosis post-angioplasty in 13 patients (72%). A total of 24 stents were implanted. Mean intervention time was 247+/-97min and technical success rate was 100%. Median hospital stay was 11 days. At 30 days, TLR was 88%, freedom from MA was 94% and all patients were alive. Mean follow-up was 5 months: reintervention was needed in 3 additional patients (mean time between reintervention and index procedure was 7 months), 1 patient died, and 2 patients had MA.

Magmaris stents seem to be a safe and effective technique for BTK lesions in PAD. Longer follow-up is needed to confirm these encouraging short term results. These stents could offer in the future a novel solution by combining the benefits of temporary vessel scaffolding with the long-term advantages of bioresorption.