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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 1998 August;39(4):393-8

language: English

Autol­o­gous ­vein ­lined and ­vein cov­ered ­stents in ­swine ­arteries. An experi­mental ­study to ­assess and com­pare ­patency and ­intimal hyper­plastic ­response

Byer A., Ussia G.*, Galleti G.*

From the Depart­ment of Sur­gery, Hack­en­sack Uni­ver­sity Med­ical ­Center, UMDNJ Med­ical ­School, Hack­en­sack, NJ, USA
* Insti­tute for Sur­gical ­Research Faculty of Med­i­cine and Sur­gery, Uni­ver­sity of ­Bologna, ­Italy


Back­ground. ­Despite the suc­cess of arte­rial angio­plasty as ­well as arte­rial ­stent place­ment, resten­osis ­remains a sig­nif­i­cant ­problem in pro­longing ­blood ­vessel ­patency. ­This ­animal ­model was ­used to ­test the ­theory ­that a ­stent ­lined (VLS) or cov­ered (VCS) ­with autol­o­gous ­vein ­would be ­more bio­log­i­cally com­pat­ible ­with the arte­rial ­intima. If suc­cessful, ­this tech­nique ­would pre­vent angio­plasty ­failure due to ­intimal hyper­plasia (IH) by sup­plying a ­healthy endo­the­lial sur­face and ­help to elim­i­nate ­elastic ­recoil mech­a­nism (ERM) by the use of a ­stent ren­dered ­less throm­bo­genic in ­both ste­nosed and resten­osed ­arteries. ­There ­might in addi­tion, be ­other appli­ca­tions for ­these mod­i­fied ­stents.
­Methods. ­Nine 50 kg -young ­pigs had Gian­turco-­Roubin VLS and VCS ­mounted on a bal­loon angio­plasty cath­eter ­implanted via a trans­verse arter­i­otomy. VLS ­were ­implanted in 3 ­left ­iliac and 6 ­left ­carotid ­arteries and VCS ­were ­placed in the ­matching con­tra­lat­eral ­arteries. The ­change ­from ­iliac to ­carotid ­arteries was due to the ­initial per­cep­tion ­that the ­iliac ­artery was the ­right ­size for ­this ­device. It ­proved to be too ­large and the ­carotid ­artery, ­which was ­initially ­felt to be too ­small ­proved to be the ­right ­size. Oper­a­tive angio­graphy was per­formed to ­ensure ­proper place­ment. ­Duplex ­imaging of the ­carotid ­artery place­ments ­were per­formed at 10-14 ­days. All ani­mals ­were sac­ri­ficed at 30-33 ­days and spec­i­mens exam­ined ­grossly and micro­scop­i­cally. ­Three 16.5% of the ­devices ­were ­found to be ­patent, two VLS and one VCS. The ­remaining 14 (78%) ­were ­occluded ­ by dis­tor­tion or ­thrombus or both.
­Results. ­Five ­devices ­migrated dis­tally, 2 of ­which ­remained ­patent ­albeit of ­smaller diam­eter. One ­device ­migrated to the ­brain, was not recov­ered and was pre­sumed ­occluded. All ­arteries and ­veins, ­with two excep­tions, dem­on­strated var­ying ­degrees of IH. We ­believe ­failure was due to the ­inability of the ­stents to ­resist ERM in ­these ­healthy pig ­arteries. The IH ­observed, we ­believe, is due to the ­forced dil­a­ta­tion ­required to ­seat the ­devices.
Con­clu­sions. ­Based on the obser­va­tions of the ­patent ­devices we sug­gest ­that ­arteries can be ­relined and sup­ported ­with mod­ifi­ca­tions of ­this tech­nique, ­using a ­more ERM ­resistant ­stent ­that may be ­placed ­without ­forceful dil­a­ta­tion. ­This ­will ­require fur­ther ­study.

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