In most endovascular procedures, the objective is straightforward: to restore the vessel lumen and maintain patency. However, in cases of perforation, rupture, aneurysm, or fistula, an additional challenge arises — sealing the defect or excluding the pathological segment from blood flow.

Stent grafts are used in these clinical situations. They combine a metallic scaffold with a sealing membrane. What distinguishes them from conventional stents, when are they indicated, and which factors should be considered when selecting a device? We explore these questions below.

Stent vs. Stent Graft: What Is the Fundamental Difference?

A conventional stent provides mechanical support to the vessel lumen and maintains patency at the site of a lesion, such as an isolated stenosis or occlusion.

A stent graft incorporates a sealing membrane, allowing the device not only to support the lumen but also to exclude a pathological segment from blood flow.

This distinction determines the clinical approach. A conventional stent may be sufficient for an isolated stenosis or occlusion. However, when the objective is to seal a damaged vessel or exclude an aneurysm, fistula, or another pathological segment from blood flow, a stent graft may be considered.

Coronary Stenosis and Perforation: When the Objective Changes

In coronary interventions, a stent graft may be used to seal a coronary artery perforation. In this situation, the objective is to seal the defect while maintaining patency of the target artery and, where possible, preserving blood flow through significant side branches.

Device selection depends on the location and extent of the perforation, vessel diameter, segment anatomy, and the ability to position the delivery system accurately. Following implantation, angiographic assessment helps confirm defect sealing and evaluate vessel patency.

Peripheral Lesions: Maintaining Patency or Sealing a Defect

In peripheral arteries, stent grafts are used when restoring vessel patency must be combined with excluding a pathological segment from blood flow.

This is relevant in cases of aneurysms, perforations, ruptures, and fistulas. The membrane creates a barrier between the bloodstream and the vessel wall, sealing the defect, while the metallic scaffold supports the lumen and maintains structural stability.

Another application is the reconstruction of complex peripheral arterial lesions, including those in the aortoiliac segment. In these cases, stent graft selection depends on lesion morphology, the diameter and length of the target segment, access anatomy, the presence of side branches, and the ability to achieve an adequate sealing zone.

How a Stent Graft Is Delivered and Deployed

A stent graft is advanced to the target segment using a delivery system with an appropriate profile and deployed under angiographic guidance.

In balloon-expandable systems, deployment is achieved by inflating a balloon, which expands the metallic scaffold and helps the graft material appose the vessel wall. Accurate positioning is particularly important because the stent graft must fully cover the pathological segment without obstructing significant side branches.

The technical parameters of the delivery system — including its profile, length, access route, and compatibility with the introducer sheath — should be considered during procedural planning.

What Limits Stent Graft Selection?

Selection depends not only on the diameter and length of the lesion but also on the ability to establish an adequate sealing zone, preserve blood supply to significant side branches, and advance the delivery system to the target segment.

The sealing zone is particularly important. When treating a perforation, aneurysm, or fistula, the membrane must completely cover the pathological segment in accordance with the requirements of the specific device. The final choice of device diameter, length, and delivery system should be based on the anatomy, clinical indication, and instructions for use (IFU).

How to Determine Which Device Is Needed

A practical approach to device selection starts with the clinical objective rather than a specific model:

Vascular territory → lesion characteristics → procedural objective → anatomical suitability → device specifications.

If the goal is simply to support the vessel lumen after dilation or restore patency in a stenotic or occluded segment, a conventional stent may be sufficient. If the procedure must also seal a defect or exclude a pathological segment from blood flow, a stent graft may be considered.

The next step is to assess whether a specific system is suitable for the anatomy and clinical situation, taking into account the diameter and length of the lesion, access requirements, the necessary sealing zone, the presence of side branches, and delivery system specifications.

BeGraft Peripheral: An Example of a Peripheral Stent Graft

At this stage, the selection process moves from the general device category to a specific system. BeGraft Peripheral (Bentley InnoMed) is an example of a balloon-expandable stent graft designed for clinical situations in which both vessel patency restoration and sealing of a pathological segment are required.

Key System Characteristics

• Design: A strong and flexible cobalt-chromium scaffold covered with a microporous ePTFE membrane.

• Indications: Designed for use in the iliac and renal arteries to restore patency and to seal aneurysms, acute perforations, ruptures, and fistulas.

• Compatibility and configuration: The delivery system uses a 0.035-inch over-the-wire (OTW) configuration and is available with catheter lengths of 75 cm and 120 cm. It features a low profile, with introducer sheath compatibility depending on the device diameter.

The choice between a stent and a stent graft should always be based on the clinical objective, vessel anatomy, and the technical capabilities of the delivery system.

COR-Medical is the official distributor of Bentley InnoMed products in Ukraine, including stent grafts from the BeGraft, BeFlow, and BeFlared product lines.

For detailed specifications, information on available sizes, or assistance in selecting a solution for a specific clinical case, contact us at info@cor-medical.ua or call 0 800 402 400. We will provide further information and help you select a suitable system.