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Oversizing and Restenosis with Self-Expanding Stents in Iliofemoral Arteries

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Abstract

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 (5–6 mm) 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 5 months.

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.

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References

  1. Schurmann K, Mahnken A, Meyer J et al (2002) Long-term results 10 years after iliac arterial stent placement. Radiology 224:731–738

    Article  PubMed  Google Scholar 

  2. Schillinger M, Sabeti S, Loewe C et al (2006) Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. N Engl J Med 354:1879–1888

    Article  PubMed  CAS  Google Scholar 

  3. Laird JR, Katzen BT, Scheinert D et al (2010) Nitinol stent implantation versus balloon angioplasty for lesions in the superficial femoral artery and proximal popliteal artery: twelve-month results from the RESILIENT randomized trial. Circ Cardiovasc Interv 3:267–276

    Article  PubMed  Google Scholar 

  4. Karthik S, Tuite DJ, Nicholson AA et al (2007) Cryoplasty for arterial restenosis. Eur J Vasc Endovasc Surg 33:40–43

    Article  PubMed  CAS  Google Scholar 

  5. Vorwerk D, Redha F, Neuerburg J et al (1994) Neointima formation following arterial placement of self-expanding stents of different radial force: experimental results. Cardiovasc Intervent Radiol 17:27–32

    Article  PubMed  CAS  Google Scholar 

  6. Schurmann K, Vorwerk D, Kulisch A et al (1996) Neointimal hyperplasia in low-profile nitinol stents, palmaz stents, and wallstents: a comparative experimental study. Cardiovasc Intervent Radiol 19:248–254

    Article  PubMed  CAS  Google Scholar 

  7. Zeller T (2007) Current state of endovascular treatment of femoro-popliteal artery disease. Vasc Med 12:223–234

    Article  PubMed  Google Scholar 

  8. Zhao HQ, Nikanorov A, Virmani R et al (2009) Late stent expansion and neointimal proliferation of oversized nitinol stents in peripheral arteries. Cardiovasc Intervent Radiol 32:720–726

    Article  PubMed  Google Scholar 

  9. Stoeckel D, Pelton A, Duerig T (2004) Self-expanding nitinol stents: material and design considerations. Eur Radiol 14:292–301

    Article  PubMed  Google Scholar 

  10. Windecker S, Mayer I, De Pasquale G et al (2001) Stent coating with titanium-nitride-oxide for reduction of neointimal hyperplasia. Circulation 104:928–933

    Article  PubMed  CAS  Google Scholar 

  11. Flueckiger A, Strahm Y, Billinger M et al (2009) Intimal proliferation and restenosis in paclitaxel-eluting stents with aminoparylene as carrier substance in swines. J Invasive Cardiol 21:128–132

    PubMed  Google Scholar 

  12. Billinger M, Buddeberg F, Hubbell JA et al (2006) Polymer stent coating for prevention of neointimal hyperplasia. J Invasive Cardiol 18:423–426 discussion 427

    PubMed  Google Scholar 

  13. Liu Y, Dang C, Garcia M et al (2007) Surrounding tissues affect the passive mechanics of the vessel wall: theory and experiment. Am J Physiol Heart Circ Physiol 293:H3290–H3300

    Article  PubMed  CAS  Google Scholar 

  14. Schwartz RS, Huber KC, Murphy JG et al (1992) Restenosis and the proportional neointimal response to coronary artery injury: results in a porcine model. J Am Coll Cardiol 19:267–274

    Article  PubMed  CAS  Google Scholar 

  15. Han RO, Schwartz RS, Kobayashi Y et al (2001) Comparison of self-expanding and balloon-expandable stents for the reduction of restenosis. Am J Cardiol 88:253–259

    Article  PubMed  CAS  Google Scholar 

  16. Clark DJ, Lessio S, O’Donoghue M et al (2006) Mechanisms and predictors of carotid artery stent restenosis: a serial intravascular ultrasound study. J Am Coll Cardiol 47:2390–2396

    Article  PubMed  Google Scholar 

  17. Carter AJ, Laird JR, Farb A et al (1994) Morphologic characteristics of lesion formation and time course of smooth muscle cell proliferation in a porcine proliferative restenosis model. J Am Coll Cardiol 24:1398–1405

    Article  PubMed  CAS  Google Scholar 

  18. Sabeti S, Schillinger M, Amighi J et al (2004) Primary patency of femoropopliteal arteries treated with nitinol versus stainless steel self-expanding stents: propensity score-adjusted analysis. Radiology 232:516–521

    Article  PubMed  Google Scholar 

  19. Sabeti S, Mlekusch W, Amighi J et al (2005) Primary patency of long-segment self-expanding nitinol stents in the femoropopliteal arteries. J Endovasc Ther 12:6–12

    Article  PubMed  Google Scholar 

  20. Ansel GM, Lumsden AB (2009) Evolving modalities for femoropopliteal interventions. J Endovasc Ther 16:II82–II97

    Article  PubMed  Google Scholar 

  21. Krankenberg H, Schluter M, Steinkamp HJ et al (2007) Nitinol stent implantation versus percutaneous transluminal angioplasty in superficial femoral artery lesions up to 10 cm in length: the femoral artery stenting trial (FAST). Circulation 116:285–292

    Article  PubMed  CAS  Google Scholar 

  22. Kasapis C, Henke PK, Chetcuti SJ et al (2009) Routine stent implantation vs. percutaneous transluminal angioplasty in femoropopliteal artery disease: a meta-analysis of randomized controlled trials. Eur Heart J 30:44–55

    Article  PubMed  Google Scholar 

  23. Duda SH, Bosiers M, Pusich B et al (2002) Endovascular treatment of peripheral artery disease with expanded PTFE-covered nitinol stents: interim analysis from a prospective controlled study. Cardiovasc Intervent Radiol 25:413–418

    Article  PubMed  CAS  Google Scholar 

  24. Duda SH, Bosiers M, Lammer J et al (2005) Sirolimus-eluting versus bare nitinol stent for obstructive superficial femoral artery disease: the SIROCCO II trial. J Vasc Interv Radiol 16:331–338

    Article  PubMed  Google Scholar 

  25. Lammer J, Bosiers M, Zeller T et al (2011) First clinical trial of nitinol self-expanding everolimus-eluting stent implantation for peripheral arterial occlusive disease. J Vasc Surg 54:394–401

    Article  PubMed  Google Scholar 

  26. Tang GL, Morasch MD (2007) Role of stents, drug-eluting stents, and stent-grafts in treatment of infrainguinal arterial disease. Semin Vasc Surg 20:37–41

    Article  PubMed  Google Scholar 

  27. Windecker S, Simon R, Lins M et al (2005) Randomized comparison of a titanium-nitride-oxide-coated stent with a stainless steel stent for coronary revascularization: the TiNOX trial. Circulation 111:2617–2622

    Article  PubMed  CAS  Google Scholar 

  28. Pilgrim T, Raber L, Limacher A et al (2011) Comparison of titanium-nitride-oxide-coated stents with zotarolimus-eluting stents for coronary revascularization a randomized controlled trial. JACC Cardiovasc Interv 4:672–682

    Article  PubMed  Google Scholar 

  29. Minar E (2011) Drug-eluting stents above the knee. J Cardiovasc Surg (Torino) 52:225–229

    CAS  Google Scholar 

  30. Traupe T, Stettler CD, Li H et al (2007) Distinct roles of estrogen receptors alpha and beta mediating acute vasodilation of epicardial coronary arteries. Hypertension 49:1364–1370

    Article  PubMed  CAS  Google Scholar 

  31. Dake MD, Van Alstine WG, Zhou Q et al (2011) Polymer-free paclitaxel-coated Zilver PTX Stents-evaluation of pharmacokinetics and comparative safety in porcine arteries. J Vasc Interv Radiol 22:603–610

    Article  PubMed  Google Scholar 

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Acknowledgments

The study was supported by an unrestricted grant of Hexacath SA, Paris, France. The authors thank O. Beslac for expert technical assistance. This work is dedicated to our mentor, Otto M. Hess, who is deeply missed.

Conflicts of interest

The authors do not have any conflicts of interest to report.

Author information

Authors and Affiliations

  1. Swiss Cardiovascular Center, University Hospital, Bern, Switzerland

    Ardan M. Saguner, Tobias Traupe, Lorenz Räber, Nina Hess, Arhan R. Saguner, Nicolas Diehm & Otto M. Hess

  2. Institute of Pathology, University of Bern, Bern, Switzerland

    Yara Banz

  3. Clinic for Cardiology, University Hospital, Raemistrasse 100, 8091, Zurich, Switzerland

    Ardan M. Saguner

Authors
  1. Ardan M. Saguner
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  2. Tobias Traupe
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  3. Lorenz Räber
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  4. Nina Hess
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  5. Yara Banz
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  6. Arhan R. Saguner
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  7. Nicolas Diehm
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  8. Otto M. Hess
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Corresponding author

Correspondence to Ardan M. Saguner.

Additional information

Otto M. Hess—deceased.

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Saguner, A.M., Traupe, T., Räber, L. et al. Oversizing and Restenosis with Self-Expanding Stents in Iliofemoral Arteries. Cardiovasc Intervent Radiol 35, 906–913 (2012). https://doi.org/10.1007/s00270-011-0275-y

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  • DOI: https://doi.org/10.1007/s00270-011-0275-y

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