Page 9 - Journal of Structural Heart Disease Volume 3, Issue 6

Original Research Article
Journal of Structural Heart Disease, December 2017, Volume 3, Issue 6:165-175
DOI: https://doi.org/10.12945/j.jshd.2017.030.17
Received: June 26, 2017 Accepted: July 04, 2017 Published online: December 2017
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, United States
2 Cook Medical, Bloomington, Indiana, United States
3 Cook Research Incorporated, West Lafayette, Indiana, United States
4 Department of Molecular, Cell and Developmental Biology, University of California, Los Angeles, California, United States 5 Rady Children's Hospital, University of California San Diego, San Diego, California, United States
Abstract
Background: Intentional stent fracture in vivo induc- es medial dissection/vessel injury. Spontaneous stent fracture in humans can lead to stent collapse, hemo- dynamic compromise, and embolization of stent frag- ments, which could be prevented by pre-stenting. Objectives: To evaluate the short-term and mid-term e ects of pre-stenting prior to intentional stent frac- ture on vessel size and integrity in a piglet model. Methods: Five months after 14 low-pro le 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 signi cantly 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 be- tween groups at the time of stent fracture; however, the injury score was signi cantly 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 frac- ture may provide advantages including larger vessel diameter, maintained vessel patency, more complete endothelialization, and lack of stent strut protrusion. Copyright © 2017 Science International Corp.
Key Words
Stent Fracture • Coarctation • Intentional stent fracture
Introduction
Stent implantation in younger patients is facilitated by the availability of low-pro le stents that are deliv- erable through small delivery sheaths, although these smaller stents cannot be dilated to match an adult vessel size [1-3]. Several in vitro studies demonstrate that small- and medium-size stents can be fractured using ultra-high-pressure balloons [4, 5]. Recently, an in vivo model of stent fracture (i.e., “unzipping”) con- rmed the feasibility of intentional fracture of several di erent stents in pigs; however, the report did not mention vessel patency after fracture and admitted to signi cant vessel injury secondary to intentional fracture, with Cook Formula stents associated with a slightly lower vessel injury score than other stents
* Corresponding Author:
Howaida el-Said, MD, PhD
Rady Children's Hospital
University of California San Diego
3020 Children’s Way, San Diego, CA 92123, USA
Tel. +1 914 409 3091; Fax: +1 858 966 7903; E-Mail: hgelsaid@yahoo.com
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2017 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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