Carotid Artery Stenting Using a Novel Self-Expanding Braided Nickel-Titanium Stent: Feasibility and Safety Porcine Trial

Journal Article · Tue Sep 15 00:00:00 EDT 2009 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-009-9572-0· OSTI ID:21429114

Ahlhelm, Frank; Kaufmann, Ralf ^[1]; Ahlhelm, Dirk; Ong, Mai Fang ^[2]; Roth, Christian; Reith, Wolfgang ^[1]

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1. Saarland-University, Clinic for Diagnostic and Interventional Neuroradiology, School of Medicine (Germany)
2. Saarland-University, School of Medicine (Germany)

We studied the deliverability and safety of a braided, self-expanding, closed-cell nickel-titanium (NiTi) stent (E-volution, Jotec GmbH, Hechingen, Germany) especially designed for the endovascular treatment of carotid artery bifurcation stenosis with special regard to in-stent stenosis and thrombosis compared with a laser-cut reference nitinol stent in a porcine model of percutaneous vascular interventions. We aimed to assess histopathologic response in minipig carotid and subclavian arteries. Eight minipigs received a total of 42 stents: 14 reference stents and 28 E-volution stents. Eleven of the E-volution stents were additionally coated with heparin. Control angiography was obtained immediately before and after vascular intervention as well as 4 weeks after the procedure. Primary endpoints were 28 days of angiographic analyses as well as histomorphometric analysis, including injury score, inflammation score, luminal diameter, vessel diameter, maximal neointimal thickness, and area of in-stent stenosis. Secondary end points were procedural success, 28-day mortality, and stent thrombosis. All stents could be delivered successfully without procedural complications, morbidity, or mortality during our observation time. As confirmed by histology, no in-stent thrombosis was observed. Compared with common carotid arteries, subclavian arteries are significantly more vulnerable to developing in-stent stenosis caused by neointima proliferation (p < 0.05). Compared with the use of 1 single stent/artery, serial application of two stents leads to a more excessive but not significantly different neointimal proliferation (p > 0.05). The E-volution stent, especially when heparin coated, is in line with the comparison to the laser-cut reference stent displaying similar results of angiographic, histologic, and histomorphometric analyses (p > 0.05). Compared with the reference laser-cut stent, the self-expanding nitinol stent (E-volution) with its advanced braiding technology is feasible and safe. In our opinion, the high radial resistive force and the advanced braided design with tight stent-strut interstices may be beneficial in terms of plaque stabilization. Further studies are necessary and warranted.

• OSTI ID: 21429114
• Journal Information: Cardiovascular and Interventional Radiology, Vol. 32, Issue 5; Other Information: DOI: 10.1007/s00270-009-9572-0; Copyright (c) 2009 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Article Copyright (c) 2009 The Author(s); ISSN 0174-1551
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BIFURCATION
BIOMEDICAL RADIOGRAPHY
CAROTID ARTERIES
HEPARIN
INFLAMMATION
INJURIES
NICKEL ALLOYS
PHENOBARBITAL
THROMBOSIS
TITANIUM ALLOYS
TUBES
ALLOYS
AMINES
ANESTHETICS
ANTICOAGULANTS
ANTICONVULSANTS
ARTERIES
AZINES
BARBITURATES
BLOOD VESSELS
BODY
CARBOHYDRATES
CARDIOVASCULAR DISEASES
CARDIOVASCULAR SYSTEM
CENTRAL NERVOUS SYSTEM AGENTS
CENTRAL NERVOUS SYSTEM DEPRESSANTS
DIAGNOSTIC TECHNIQUES
DISEASES
DRUGS
HEMATOLOGIC AGENTS
HETEROCYCLIC COMPOUNDS
HYPNOTICS AND SEDATIVES
MEDICINE
MUCOPOLYSACCHARIDES
NUCLEAR MEDICINE
ORGANIC COMPOUNDS
ORGANIC NITROGEN COMPOUNDS
ORGANIC OXYGEN COMPOUNDS
ORGANIC SULFUR COMPOUNDS
ORGANS
PATHOLOGICAL CHANGES
POLYSACCHARIDES
PYRIMIDINES
RADIOLOGY
SACCHARIDES
SYMPTOMS
TRANSITION ELEMENT ALLOYS
VASCULAR DISEASES