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CardioVascular and Interventional Radiology

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01-08-2012 | Laboratory Investigation

Oversizing and Restenosis with Self-Expanding Stents in Iliofemoral Arteries

Authors: Ardan M. Saguner, Tobias Traupe, Lorenz Räber, Nina Hess, Yara Banz, Arhan R. Saguner, Nicolas Diehm, Otto M. Hess

Published in: CardioVascular and Interventional Radiology | Issue 4/2012

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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Title: Oversizing and Restenosis with Self-Expanding Stents in Iliofemoral Arteries
Authors: Ardan M. Saguner
Tobias Traupe
Lorenz Räber
Nina Hess
Yara Banz
Arhan R. Saguner
Nicolas Diehm
Otto M. Hess
Publication date: 01-08-2012
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 4/2012
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-011-0275-y

At a glance: The STEP trials

Springer Medicine

Oversizing and Restenosis with Self-Expanding Stents in Iliofemoral Arteries

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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