MicroStent — a Novel Device Designed for Treatment of CLTI BTK

Best Practices and Outcomes for Primary Treatment or Bailout in European HEAL Observational Study

Marco Manzi, MD1; Lieven Maene, MD2; Michael Lichtenberg, MD3; Wouter Lansink, MD4; Daniel van den Heuvel, MD5; Andrej Schmidt, MD6; Dierk Scheinert, MD7; Marianne Brodmann, MD8; Mariano Palena, MD1,8; Koen Deloose, MD7

From 1Policlinico Abano Terme Padova Italy, 2Onze Lieve Vrouwziekenhuis (OLV) Aalst Belgium, 3Karolinen Hospital Arnsberg Germany, 4Ziekenhuis Oost-Limburg (ZOL) Genk Belgium, 5St. Antonius Hospital Nieuwegein Netherlands, 6University Hospital Leipzig, Germany, 7University Hospital LKH Graz Austria, 8Maria Cecilia Hospital, Cotignola Italy, 9A.Z. St. Blasius Dendermonde Belgium.

NOTE: During the study period, Mariano Palena’s affiliation was Maria Cecilia Hospital, Catignona Italy where he enrolled some patients; however, he recently joined Dr Manzi at the Policlinico Abano Terme, Padova, Italy.

The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.
The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted September 19, 2022.
Address for correspondence: Dr. Marco Manzi, Policlinico Abano Terme, Padova Italy, Email:


Objective. To evaluate the technical aspects of the MicroStent, a novel device specifically designed for the treatment of chronic limb-threatening ischemia (CLTI) below the knee (BTK) when used as primary treatment or as bailout in patients enrolled in the HEAL study, a post-market multicenter European all-comers observational study. Methods. All consecutive patients enrolled were evaluated at follow-up visits at 30 days, 6 months, 12 months and 24 months, including duplex Ultrasound evaluation of the target lesion.

Evaluation included: patient demographics, target lesion characteristics, MicroStent implantation details which included primary and bailout usage, sizing, and pre- and post-dilatation strategies.

Primary outcome measures were: primary patency at 6 months and freedom from MALE and POD at 30 days. Secondary outcome measures were: device and technical success, freedom from MALE and major amputation at 6, 12 and 24 months and freedom from CD-TLR at 6, 12 and 24 months and wound healing status at 6, 12 and 24 months.

Results. In total 78 patients were enrolled and 77 were implanted with the MicroStent, representing 78 lesions and a total of 91 MicroStent devices. Patients treated had a median age of 76 (range 46-92). Rutherford category ranged from 3 to 6: 9.1% were category 3, 19.5% were category 4, 68.8% were category 5 and 2.6% were category 6.

Medical history included: diabetes 75.3%, history of CAD 29.9%, history of peripheral intervention 45.9%, history of amputation 21.6%. Median target lesion length was 45 mm (range 10-400 mm); 51.9% pre-treatment target lesion were CTOs and 59.8% were moderate to severely calcified. MicroStents were implanted as primary treatment in 52.2% for the target cases, in 47.8% of the MicroStents were implanted as bailout options. Overall primary patency (regardless of relationship to the MicroStent) was 71% at 6 months. Device related primary patency, where the MicroStent was implanted for primary treatment of the target lesion, was 96.9% at 6 months; device related primary patency, where the MicroStent was implanted as bailout option after failed treatment of the target lesion, was 100% at 6 months. Freedom from MALE and POD (regardless of relationship to the MicroStent) was 95.9% at 30 days and 90.0% at 6 months. Device success was 98.9%. Technical success was 100%. The freedom from major amputation at 30 days and 6 months were respectively 97.3% and 94.9%. The freedom from major target lesion reintervention at 30 days and at 6 months were respectively 98.6% and 96.5%.

Conclusions. Preliminary results from the HEAL Study suggest that patients requiring treatment of PAD and CLTI in the lower limb, can be safely and effectively treated with the MicroStent when used as a primary treatment or bailout option after a failed treatment of the target lesion. HEAL Study enrollment and follow-up is ongoing.

J CRIT LIMB ISCHEM 2022;2(2):Exc=Exv

About Chronic Limb-Threatening Ischemia
Peripheral artery disease and chronic limb-threatening ischemia (CLTI) affect millions each year. People with CLTI are at greater risk for amputation and cardiovascular morbidity and mortality.1 Within 1 year of diagnosis, patients have a 15% to 20% rate of amputation and a 15% to 40% mortality rate.2 For more information on CLTI, visit

  1. Barnes JA, Eid MA, Creager MA, Goodney PP. Epidemiology and Risk of Amputation in Patients With Diabetes Mellitus and Peripheral Artery Disease. Arterioscler Thromb Vasc Biol. 2020 Aug;40(8):1808-1817.
  2. Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007-2017.Cardiovasc Diabetol. 2018;17:83.

About Micro Medical Solutions

Micro Medical Solutions is on a mission to provide solutions to some of the most pressing unmet needs in microvascular intervention by helping to significantly reduce the rate of amputations, improve clinical outcomes and patient quality of life, and minimize the financial and human costs associated with the treatment of peripheral artery disease and chronic limb ischemia. For more about Micro Medical Solutions, visit

CONTACT: Peg Thornton, Director of Corporate and Market Development, Micro Medical Solutions 732-616-9123

About CLI

Peripheral artery disease (PAD) and critical limb ischemia (CLI) affected 215 million people worldwide in 2015, predicted to be 230 million by 2020.1 CLI currently afflicts 2.8 to 3.5 million of those with PAD and is projected to rise to 4.5 to 5.6 million.2 Rates of amputations in the general population with PAD are declining, but amputations in CLI continue to escalate. It has been estimated that 25% of CLI patients will undergo major amputation. Prognosis with respect to limb preservation in CLI patients is poor, particularly in no-option CLI patients, where six-month major amputation rates have been reported to be as high as 50%.3 If something doesn’t change, the number of amputations due to CLI could exceed one million by 2030.

References: 1. Global Peripheral Artery Disease Market: Trends & Opportunities (2015-2020), February 2016 (Page 19). Daedal Research Group. 2. Critical Limb Ischemia. Volume 1 United States Epidemiology, 2010. Accessed at[orts/cliepiusreprot.php., October 14, 2016. 3. Teraa M, Conte MS, Moll FL, Verhaar MC. Contemporary Reviews: Critical Limb Ischemia: Current Trends and Future Directions. J Am Heart Assoc 2016; 5: e002938.

Back To Top