Comparative Real-World Outcomes of LifeStream and Viabahn VBX Balloon-Expandable Covered Stents for Iliac Artery Occlusive Disease

<title>Abstract</title> <p> Purpose Balloon-expandable covered stents (CSs) are increasingly used for complex iliac artery occlusive disease, but direct comparative data among CS platforms remain limited. This study compared 1-year restenosis and clinical outcomes between the LifeStream and Viabahn VBX CSs in patients undergoing endovascular treatment (EVT). Methods This multicenter retrospective study included 226 patients who underwent EVT for symptomatic iliac artery occlusive disease using either the LifeStream CS (n = 95) or Viabahn VBX CS (n = 131). Outcomes included restenosis, clinically driven target lesion revascularization (CD-TLR), re-occlusion, conversion to bypass surgery, and perioperative complications (POCs). Between-group comparisons were performed using inverse probability of treatment weighting (IPTW) based on propensity scores. Exploratory interaction analyses assessed whether selected clinical, lesion, or procedural characteristics modified the association between CS type and restenosis. Results One-year follow-up data were available for 163 of 226 patients (72.1%), and 10 restenosis events occurred during follow-up. After IPTW adjustment, the balance of measured covariates was substantially improved. The estimated 1-year freedom from restenosis was 97.7% (95% confidence interval [CI], 94.9–100.0%) in the LifeStream group and 95.5% (95% CI, 91.9–99.3%) in the Viabahn VBX group, with no statistically significant between-group difference ( <italic>p</italic>  = 0.78). No significant differences were detected in freedom from CD-TLR (99.2% [95% CI, 97.7–100.0%] vs. 96.1% [95% CI, 92.6–99.7%]; <italic>p</italic>  = 0.48), re-occlusion (100.0% [95% CI, 100.0–100.0%] vs. 97.8% [95% CI, 95.1–100.0%]; <italic>p</italic>  = 0.30), conversion to bypass surgery (100.0% [95% CI, 100.0–100.0%] vs. 98.2% [95% CI, 96.1–100.0%]; <italic>p</italic>  = 0.40), or POCs. No statistically significant interaction was observed for any evaluated characteristic (all <italic>p</italic> values for interaction &gt; 0.05). Conclusion In this IPTW-adjusted multicenter retrospective study, no statistically significant differences in 1-year restenosis or other clinical outcomes were detected between the LifeStream and Viabahn VBX balloon-expandable CSs. These findings should be considered hypothesis-generating because of the small number of events, incomplete follow-up, and potential residual confounding. </p>