Landmark C-TRACT trial confirms the case for iliac vein stenting

20 October 2026

New NEJM trial adds important evidence to the case for endovascular treatment of post-thrombotic syndrome.

Vedantham et al., N Engl J Med 2026;394:2293-2304.

A major new trial published in the New England Journal of Medicine by Vedantham et al. adds important evidence to the case for endovascular treatment of post-thrombotic syndrome, the chronic condition that can follow deep-vein thrombosis and significantly impair patients' quality of life. The C-TRACT trial, a phase 3, multicentre, randomised controlled trial, involved 225 patients across 29 US centres, comparing iliac-vein stent placement plus enhanced antithrombotic therapy against standard care alone in patients with moderate to severe post-thrombotic syndrome and confirmed iliac-vein obstruction.

At 6 months, patients who received endovascular therapy showed significantly less severe post-thrombotic syndrome and meaningfully better venous disease-specific and overall quality of life than those receiving standard care alone. Bleeding was more common in the stented group, a trade-off the study's authors noted is associated with the enhanced antithrombotic therapy used to support stent patency.

Why this matters for iliac venous stenting

Post-thrombotic syndrome affects a large proportion of patients following DVT, and the C-TRACT findings reinforce what has driven our work from the outset: opening and maintaining iliac venous outflow can meaningfully change patients' lives. The trial's results also highlight the areas where the current generation of venous stents can still be improved, particularly around long-segment coverage in the naturally tapered, curved, and dynamic anatomy of the iliac veins, where traditional continuous tubular stent designs can face conformity challenges.

As the evidence base for iliac vein stenting continues to grow, we remain focused on bringing ALTA® through clinical development and towards the patients who stand to benefit.

Access the full trial publication (paywall): https://www.nejm.org/doi/full/10.1056/NEJMoa2519001

The ALTA® stent is currently under development, intended exclusively for investigational use, and is not approved for sale in any geography.