Background: With the recent improvement of device and endovascular treatment (EVT) technique, the success rate of chronic total occlusion (CTO) in ilio-femoral artery is very high; however, there are limited data regarding the impact of Stent implantation on the clinical outcomes as compared with balloon angioplasty alone, especially in Asian population. Methods: This study consisted of 187 consecutive critical limb ischemia (CLI) patients (pts) underwent PTA in a single Asian center. Among these pts, a total 121 (64.7%) CLI pts presented with ilio-femoral artery lesion (156 limbs, 189 lesions) and 75 pts were treated with Stents (100 Limb, 107 lesions). Provisional stenting was done once the balloon angioplasty outcome is not optimal, mainly by self-expanding nitinol stents. Periprocedural complications and clinical outcomes up to 12 months were compared between the two groups. Results: The baseline clinical characteristics were different between the two groups. Balloon group more higher grade of Rutherford Chronic Limb Ischemia Classification (Grade 2,3; 77% vs. 39%, p=0.01), had more diabetes (76% vs. 57%, p=0.04), wound (69% vs. 25%, P<0.001) and below the knee lesions (65% vs. 18%, p<0.001). Stent group had more cerebrovascular accident (2% vs. 4%, p<0.001) and CTO lesions (31% vs. 51%, p=0.036). Overall procedural success rate was 98.3%, and there was no difference in procedural success rate between the two groups with similar rates of periprocedural complications. Major clinical outcomes including mortality, repeat revascularization and the incidence of surgical intervention were similar between the two groups (Table). After the adjustment of baseline differences, still the major clinical outcomes were similar between the two groups. Conclusion: Once the significant ilio-femoral lesions were successfully treated either by balloon angioplasty alone or provisional stenting, major mid-term angiographic and clinical outcomes were similar between two treatment modality.