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Oversizing and Restenosis with Self-Expanding Stents in Iliofemoral Arteries

Saguner, Ardan ; Traupe, Tobias ; Räber, Lorenz ; Hess, Nina ; Banz, Yara ; Saguner, Arhan ; Diehm, Nicolas ; Hess, Otto

In: CardioVascular and Interventional Radiology, 2012, vol. 35, no. 4, p. 906-913

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    Titre
    • Oversizing and Restenosis with Self-Expanding Stents in Iliofemoral Arteries
    Auteur
    • Saguner, Ardan. Swiss Cardiovascular Center, University Hospital, Bern, Switzerland
    • Traupe, Tobias. Swiss Cardiovascular Center, University Hospital, Bern, Switzerland
    • Räber, Lorenz. Swiss Cardiovascular Center, University Hospital, Bern, Switzerland
    • Hess, Nina. Swiss Cardiovascular Center, University Hospital, Bern, Switzerland
    • Banz, Yara. Institute of Pathology, University of Bern, Bern, Switzerland
    • Saguner, Arhan. Swiss Cardiovascular Center, University Hospital, Bern, Switzerland
    • Diehm, Nicolas. Swiss Cardiovascular Center, University Hospital, Bern, Switzerland
    • Hess, Otto. Swiss Cardiovascular Center, University Hospital, Bern, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • CardioVascular and Interventional Radiology, 2012, vol. 35, no. 4, p. 906-913. Springer-Verlag
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:310955
    Summary
    Purpose: Uncoated self-expanding nitinol stents (NS) are commonly oversized in peripheral arteries. In current practice, 1-mm oversizing is recommended. Yet, oversizing of NS may be associated with increased restenosis. To provide further evidence, NS were implanted in porcine iliofemoral arteries with a stent-to-artery-ratio between 1.0 and 2.3. Besides conventional uncoated NS, a novel self-expanding NS with an antiproliferative titanium-nitride-oxide (TiNOX) coating was tested for safety and efficacy. Methods: Ten uncoated NS and six TiNOX-coated NS (5-6mm) were implanted randomly in the iliofemoral artery of six mini-pigs. After implantation, quantitative angiography (QA) was performed for calculation of artery and minimal luminal diameter. Follow-up was performed by QA and histomorphometry after 5months. Results: Stent migration, stent fracture, or thrombus formation were not observed. All stents were patent at follow-up. Based on the location of the stent (iliac/femoral) and the stent-to-artery-ratio, stent segments were divided into "normal-sized” (stent-to-artery-ratio<1.4, n=12) and "oversized” (stent-to-artery-ratio≥1.4, n=9). All stent segments expanded to their near nominal diameter during follow-up. Normal-sized stent segments increased their diameter by 6% and oversized segments by 29%. A significant correlation between oversizing and restenosis by both angiography and histomorphometry was observed. Restenosis rates were similar for uncoated NS and TiNOX-coated NS. Conclusions: TiNOX-coated NS are as safe and effective as uncoated NS in the porcine iliofemoral artery. All stents further expand to near their nominal diameter during follow-up. Oversizing is linearly and positively correlated with neointimal proliferation and restenosis, which may not be reduced by TiNOX-coating