‘Kissing stent’ insertion is not safe or durable

Background: The morbidity, and clinical and haemodynamic outcome of kissing stent insertion was assessed. Methods: A prospectively gathered database of endovascular procedures performed between 1 January 1993 and 31 December 1998 was analysed. Results: Bilateral kissing stents were deployed in 12 patients (median age 62 (range 43–67) years; five men and seven women). Indications were bilateral intermittent claudication (IC) in nine patients, unilateral IC with contralateral rest pain in two and bilateral rest pain/tissue loss in one. Major morbidity occurred in three patients and comprised bilateral distal iliac dissection (treated medically), distal embolization (thrombolysis and suction aspiration) and false aneurysm (surgical repair). All patients reported an immediate improvement in symptoms. However, at a median (range) follow‐up of 27 (3–70) months, symptoms have deteriorated in 13 legs, the ankle: brachial pressure index has fallen by more than 0·15 (with respect to values immediately after the procedure) in 15 legs, six stents have occluded (bilaterally in two patients, unilaterally in two) and four stents have stenosed significantly (greater than 50 per cent). Four patients have undergone aortobifemoral grafting and one further patient has undergone bilateral amputation following failed revascularization necessitated by stent thrombosis. Conclusion: In contrast to the single previously published series of 20 patients which found the technique to be ‘effective’ with ‘few serious adverse events’, present data suggest that kissing stents are associated with significant morbidity and a poor outcome. © 2000 British Journal of Surgery Society Ltd