Original Research Article
Download PDF (7.07 MB)
Journal of Structural Heart Disease, December 2017, Volume 3, Issue 6:165-175
DOI: 10.12945/j.jshd.2017.030.17
Intentional Fracture of Previously Placed Stents: Impact of Pre-stenting in a Piglet Model
András Bratincsák, MD, PhD1, William Van Alstine, DVM, PhD, DACVP3, Lindsay Koren, BE2, Kimberly Stoughton, CVT3, José Negrón-Garcia, CVT3, Anthony Ragheb, PhD2, Hannah El-Sabrout, HSDG4, John W. Moore, MD, MPH5, Howaida el-Said, MD, PhD5
1 Kapi'olani Medical Center for Women and Children, University of Hawaii, Honolulu, Hawaii, USA
2 Cook Medical, Bloomington, Indiana, USA
3 Cook Research Incorporated, West Lafayette, Indiana, USA
4 Department of Molecular, Cell and Developmental Biology, University of California, Los Angeles, California, USA
5 Rady Children's Hospital, University of California San Diego, San Diego, California, USA
Abstract
Background: Intentional stent fracture in vivo induces medial dissection/vessel injury. Spontaneous stent fracture in humans can lead to stent collapse, hemodynamic compromise, and embolization of stent fragments, which could be prevented by pre-stenting. Objectives: To evaluate the short-term and mid-term effects of pre-stenting prior to intentional stent fracture on vessel size and integrity in a piglet model.
Methods: Five months after 14 low-profile stents (Cook Formula 418 stents) were implanted in the aorta of four piglets, they were intentionally fractured using ultra-high-pressure balloons with (pre-stent group) or without (single stent group) with another stent placed inside.
Results: Compared with the single stent group, the pre-stent group showed a significantly larger vessel lumen area (109 mm2 (89–141) vs. 57 mm2 (47–73), P = 0.019), less mid-term luminal diameter loss (44% (26–59) vs. 75% (62–85), P = 0.007), lack of strut protrusion, and improved endothelialization (100% (89–100) vs. 73% (56–96), P = 0.022). Vessel wall injury was similar between groups at the time of stent fracture; however, the injury score was significantly improved at mid-term in the pre-stent group compared with the single stent group (P = 0.046). No damage to the external part of the blood vessels or the surrounding soft tissue was noted in either group.
Conclusion: Pre-stenting before intentional stent fracture may provide advantages including larger vessel diameter, maintained vessel patency, more complete endothelialization, and lack of stent strut protrusion.
Cite this article as: Bratincsák A, Van Alstine W, Koren L, Stoughton K, Negrón-Garcia J, Ragheb A, El-Sabrout H, Moore JW, el-Said H. Intentional Fracture of Previously Placed Stents: Impact of Pre-stenting in a Piglet Model. Structural Heart Disease 2017;3(6):165-175. DOI: 10.12945/j.jshd.2017.030.17
All comments will be screened and reviewed before posting. Statements, opinions, and results of studies published in Journal of Structural Heart Disease are those of the authors and do not reflect the policy or position of The Journal and Science International and the Editorial Board and provides no warranty as to their accuracy or reliability. Material is copyrighted and owned by Science International and cannot be used without expressed permission.
Original Research Article
Journal of Structural Heart Disease, December 2017, Volume 3, Issue 6:165-175
DOI: 10.12945/j.jshd.2017.030.17
Intentional Fracture of Previously Placed Stents: Impact of Pre-stenting in a Piglet Model
András Bratincsák, MD, PhD1, William Van Alstine, DVM, PhD, DACVP3, Lindsay Koren, BE2, Kimberly Stoughton, CVT3, José Negrón-Garcia, CVT3, Anthony Ragheb, PhD2, Hannah El-Sabrout, HSDG4, John W. Moore, MD, MPH5, Howaida el-Said, MD, PhD5
1 Kapi'olani Medical Center for Women and Children, University of Hawaii, Honolulu, Hawaii, USA
2 Cook Medical, Bloomington, Indiana, USA
3 Cook Research Incorporated, West Lafayette, Indiana, USA
4 Department of Molecular, Cell and Developmental Biology, University of California, Los Angeles, California, USA
5 Rady Children's Hospital, University of California San Diego, San Diego, California, USA
Abstract
Background: Intentional stent fracture in vivo induces medial dissection/vessel injury. Spontaneous stent fracture in humans can lead to stent collapse, hemodynamic compromise, and embolization of stent fragments, which could be prevented by pre-stenting. Objectives: To evaluate the short-term and mid-term effects of pre-stenting prior to intentional stent fracture on vessel size and integrity in a piglet model.
Methods: Five months after 14 low-profile stents (Cook Formula 418 stents) were implanted in the aorta of four piglets, they were intentionally fractured using ultra-high-pressure balloons with (pre-stent group) or without (single stent group) with another stent placed inside.
Results: Compared with the single stent group, the pre-stent group showed a significantly larger vessel lumen area (109 mm2 (89–141) vs. 57 mm2 (47–73), P = 0.019), less mid-term luminal diameter loss (44% (26–59) vs. 75% (62–85), P = 0.007), lack of strut protrusion, and improved endothelialization (100% (89–100) vs. 73% (56–96), P = 0.022). Vessel wall injury was similar between groups at the time of stent fracture; however, the injury score was significantly improved at mid-term in the pre-stent group compared with the single stent group (P = 0.046). No damage to the external part of the blood vessels or the surrounding soft tissue was noted in either group.
Conclusion: Pre-stenting before intentional stent fracture may provide advantages including larger vessel diameter, maintained vessel patency, more complete endothelialization, and lack of stent strut protrusion.
PDF
Mobile-ready Flipbook
Cite this article as: Bratincsák A, Van Alstine W, Koren L, Stoughton K, Negrón-Garcia J, Ragheb A, El-Sabrout H, Moore JW, el-Said H. Intentional Fracture of Previously Placed Stents: Impact of Pre-stenting in a Piglet Model. Structural Heart Disease 2017;3(6):165-175. DOI: 10.12945/j.jshd.2017.030.17
You must be registered and logged in to leave comments.
There have been no comments posted yet
Ask a question (publicly)
Board