Objective To investigate the effect of bare-metal stent with smaller diameter in the elderly patients with illiac artery occlusion. Methods A retrospective study was performed on 104 old patients (131 limbs) with iliac artery occlusion who were admitted in our department from July 2010 to July 2013. According to the treatment, they were divided into those with bare-metal stent with smaller diameter implacement (n=53,6-7 mm in diameter, small diameter group) and those receiving stent with common diameter (n=51,8-10 mm in diameter, control group). All the patients were followed up for 2 years after the implacement, the procedural success rate, occurrence rate of restenosis, primary patency, secondary patency, and ankle-brachial index (ABI) were observed in the both groups. SPSS statistics 21.0 was used for statistical analysis, and Student’s t test and Chi-sqaure test were employed for the comparison between the 2 groups. Results The procedural success rate was 100.0% in the both small diameter group and control group. The occurrence rates of complications and restenosis were significantly lower in the small diameter group than the control group (1.89% vs 9.80%, 9.43% vs 17.60%; P<0.05). The ABI was significantly increased in both groups after the implacement (P<0.05). In the 2 years’ follow-up, there were no differences in primary patency and second patency between the 2 groups (90.5% vs 88.2%, 96.2% vs 96.1%; P>0.05).Conclusion Bare-metal stent with smaller diameter and stent with common diameter both can be an option for the elderly patients with illiac artery occlusion.