Influence of Stent Parameters and Post-Stenting Venographic Findings on Mid-Term Patency After Thrombectomy in May–Thurner Syndrome

Background/Objectives: In May–Thurner syndrome (MTS)-related iliofemoral deep vein thrombosis (DVT), stent failure remains an important concern; however, the prognostic value of stent parameters and immediate post-stenting venographic findings is not fully defined. This study aimed to evaluate the stent patency outcomes and analyze the effect of various stent-related parameters on the risk of stent occlusion. Methods: This retrospective study included 50 patients with acute iliofemoral DVT secondary to MTS, who underwent thrombectomy followed by iliac vein stenting. Stent diameter, oversizing, stent type, and post-stenting stenosis were evaluated as predictors of primary patency. Kaplan–Meier and Cox proportional hazards analyses were performed. Results: Nine (18%) patients developed stent occlusion within the first year. The overall primary patency rates were 88% and 81.2% at 1 and 2 years, respectively. Stent diameter, oversizing, and stent type were not significantly associated with patency. In contrast, residual stenosis ≥50% on completion venography was strongly predictive of occlusion (hazard ratio, 4.625; p < 0.001). Patients without significant residual stenosis demonstrated superior patency. Conclusions: Thrombectomy with stenting provides excellent mid-term patency in MTS-related DVT, and early stent failure occurs. Residual stenosis ≥50% after stent deployment is the only significant determinant of reocclusion, whereas stent diameter, oversizing, and stent type do not influence outcomes. Achieving complete luminal restoration during the index procedure is critical for achieving long-term patency.