Fracture in drug‐eluting stents increases focal intimal hyperplasia in the atherosclerosed rabbit iliac artery
Name
nihms975513.pdf
Description
Accepted version
Size
1.25 MB
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Adobe PDF
Checksum (MD5)
98f5700bdf766202cee87f4820725fc6
Author(s)
Conway, Claire
Edelman, Elazer R
Date Issued
September 23, 2018
Journal
Catheterization and cardiovascular interventions
Publisher
Wiley
Citation
Conway, Claire et al. "Fracture in drug‐eluting stents increases focal intimal hyperplasia in the atherosclerosed rabbit iliac artery." Catheterization and cardiovascular interventions 93 (2019): 278-285 © 2018 The Author(s)
Version
Author's final manuscript
Abstract
Objectives: Drug-eluting stent (DES) strut fracture (SF) is associated with higher incidence of In-stent restenosis (ISR)—return of blockage in a diseased artery post stenting—than seen with bare metal stents (BMS). We hypothesize that concomitance of drug and SF leads to greater neointimal response. Background: Controlled release of therapeutic agents, such as sirolimus and its analogs, or paclitaxel from has reduced tissue based DES failure modes compared to BMS. ISR is dramatically reduced and yet the implications of mechanical device failure is magnified. Methods: Bilateral Xience Everolimus-eluting stents (EES) were implanted in 20 New Zealand White rabbits on normal (n = 7) or high fat (HF)/high cholesterol (HC) (n = 13) diets. Implanted stents were intact or mechanically fractured. Everolimus concentration was as packaged or pre-eluted. After 21 days, stented vessels were explanted, resin embedded, MicroCT scanned, and analyzed histomorphometrically. Results: Fractured EES were associated with significant (P < 0.05) increases in arterial stenosis and neointimal formation and lower lumen-to-artery area ratios compared to intact EES. Hyperlipidemic animals receiving pre-eluted EES revealed no significant difference between intact and fracture groups. Conclusions: SF increases intimal hyperplasia, post EES implant, and worse with more advanced disease. Pre-eluted groups, reflective of BMS, did not show significant differences, suggesting a synergistic effect of everolimus and mechanical injury, potentially explaining the lack of SF reports for BMS. Here, we report that ISR has a higher incidence with SF in EES, the clinical implication is that patients with SF after DES implantation merit careful follow-up.
Subjects
Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine
General Medicine
MIT Department
Massachusetts Institute of Technology. Institute for Medical Engineering & Science
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Creative Commons Attribution-Noncommercial-Share Alike
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DOI of Published Version
https://doi.org/10.1002/ccd.27726
