Rolland PH, Mekkaoui C, Vidal V, Berry JL, Moore JE, Moreno M, Amabile P, Bartoli JM. Compliance matching stent placement in the carotid artery of the swine promotes optimal blood flow and attenuates restenosis.
Eur J Vasc Endovasc Surg 2004;
28:431-8. [PMID:
15350569 DOI:
10.1016/j.ejvs.2004.06.018]
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Abstract
OBJECTIVES
We assessed the value of a gradient-compliant stent in an animal model.
METHODS
Bilateral carotid arteries were stented with nitinol stents having variable-oversizing, variable-stiffness, and with (CMS, 10 animals) and without (SMART, four animals) compliance-matching endings. Angiography, hemodynamic, scanning-electron-microscopic and histological analyses were performed at 3-month. The protocol was completed in 14 among 19 swines.
RESULTS
Transient (1-month) exaggerated recoil, attributable to stress-induced phasic inhibition of vasorelaxation, developed at CMS endings. At mid-term, all stents were endothelialized; CMS-stents, but not SMART-stents, were incorporated into walls (one-strut-thickness). Restenosis developed outside SMART-stents (cell migration+wall-compensatory enlargement) whereas CMS-stents elicited no or focalized cell-accumulations at endings that bulged vascular walls radially outward. SMART-stents were blood-flow neutral, whereas CMS-stents favored (higher-stiffness, higher-oversizing) or opposed (lower-stiffness, less-oversizing) carotid blood flow.
CONCLUSIONS
Direct carotid stenting with stents having compliance-matched endings and specific requirements of stiffness and oversizing can optimize blood flow to the brain and restrict local restenosis.
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