The clinical and physiological profiles of kissing stents in endovascular reconstruction of aortoiliac occlusive disease

Aortoiliac occlusive disease affecting the abdominal aorta and iliac arteries is conventionally treated with open surgical repair and is the mainstay of treatment. Endovascular techniques have become a less invasive alternative, especially for high‐risk patients. Kissing stents are particularly useful in this situation and involve the placement of two stents at the aortic bifurcation to achieve satisfactory perfusion to both the iliac arteries. These stents can be bare‐metal or covered stents with varied physiological characteristics and differing clinical outcomes. Bare‐metal stents are more prone to restenosis due to neointimal hyperplasia, whereas covered stents minimise tissue ingrowth and are associated with improved patency. Both in vitro and in vivo studies have demonstrated that stent design and deployment significantly influence blood flow patterns, shear stress and long‐term patency. Radial mismatch and turbulent flow have also been reported to impact the durability of kissing stents. Covered stents tend to outperform bare‐metal stents in complex lesions with lower reintervention rates and improved perfusion as indicated by improvement in ankle‐brachial indices. While short‐term outcomes for kissing stents are favourable, especially in high‐risk patients, long‐term patency remains a concern and requires further evaluation. This review evaluates kissing stents’ clinical performance and physiological implications in aortoiliac occlusive disease and discusses anatomical and pathological considerations in selecting the optimal endovascular strategy.