(Circulation. 1996;93:2161-2169.)
© 1996 American Heart Association, Inc.
Articles |
Paired Comparison of Vascular Wall Reactions to Palmaz Stents, Strecker Tantalum Stents, and Wallstents in Canine Iliac and Femoral Arteries
From the Vascular/Interventional Radiology Division, Georgetown University Medical Center (K.H.B., J.F., T.T., S.V.L., D.L.); the Department of Cardiovascular Pathology, Armed Forces Institute of Pathology (R.V., R.J.); and the Georgetown University Research Resources Facility (J.N.), Washington, DC.
Correspondence to Klemens H. Barth, MD, Division of Vascular and Interventional Radiology, Georgetown University Hospital, Washington, DC 20007.
Background Palmaz stents, Strecker stents, and Wallstents, all used clinically, differ substantially in their physical characteristics, yet how differently the vascular wall reacts to them has not been demonstrated conclusively. We therefore undertook a side-by-side comparison.
Methods and Results One stent was implanted into each canine external iliac and/or the flexing portion of the proximal femoral artery. In 9 dogs, Palmaz stents were placed vis-à-vis Strecker stents, with follow-up of 2 and 4 months. In 7 dogs, Palmaz stents were placed vis-à-vis Wallstents, with 4 months of follow-up. Angiographic midstent luminal diameters immediately after placement and at follow-up as well as midstent cross-sectional areas of neointima were compared for significant differences. In addition, neointimal maturation, medial atrophy, and stent-related trauma were assessed. Angiographically, all arteries remained open. The degree of luminal narrowing by recoil and neointima never reached 50% and was modest for Palmaz stents and Wallstents (P=.33) but significantly higher for Strecker stents (P<.0001 compared with Palmaz stents). This corresponded histologically to a significantly thicker neointima (P=.003) over Strecker than over Palmaz stents but not between Palmaz stents and Wallstents (P=.18). Neointimal buildup was generally more pronounced in the femoral artery segments than in the iliac segments. Maturation of the neointima over Palmaz stents was much further advanced than over Strecker stents and slightly more advanced than over Wallstents. Pressure-related atrophy of the tunica media was least for Strecker stents and more pronounced but similar for Wallstents and Palmaz stents. Wallstent wire ends caused some wall trauma; several femoral Palmaz stent struts protruded through the media.
Conclusions The lower-hoop-strength, higher-profile tantalum Strecker stent is affected by vascular wall recoil and evokes a greater degree of neointima formation than the lower-profile, higher-hoop-strength Palmaz stent and Wallstent. Medial atrophy is pronounced outside the latter two stents. The rigid Palmaz stent can penetrate through the vascular wall in flexing arteries.
Key Words: stents • arteries
This article has been cited by other articles:
 |
|
 |
|
  S. P. Lownie, D. M. Pelz, D. H. Lee, S. Men, I. Gulka, and P. Kalapos Efficacy of Treatment of Severe Carotid Bifurcation Stenosis By Using Self-Expanding Stents without Deliberate Use of Angioplasty Balloons AJNR Am. J. Neuroradiol., May 1, 2005; 26(5): 1241 - 1248. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Pearce and J. F. McKinsey Current Status of Intravascular Stents as Delivery Devices to Prevent Restenosis Vascular and Endovascular Surgery, July 1, 2003; 37(4): 231 - 237. [Abstract] [PDF]
|
|
|
|
 |
|
 M. Schillinger, M. Exner, W. Mlekusch, M. Haumer, R. Ahmadi, H. Rumpold, O. Wagner, and E. Minar Inflammatory Response to Stent Implantation: Differences in Femoropopliteal, Iliac, and Carotid Arteries Radiology, August 1, 2002; 224(2): 529 - 535. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Berkefeld, B. Turowski, A. Dietz, H. Lanfermann, M. Sitzer, T. Schmitz-Rixen, H. Steinmetz, and F. E. Zanella Recanalization Results after Carotid Stent Placement AJNR Am. J. Neuroradiol., January 1, 2002; 23(1): 113 - 120. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Hoffmann, C. Jansen, A. Konig, P.K. Haager, G. Kerckhoff, J. Vom Dahl, V. Klauss, P. Hanrath, and H. Mudra Stent design related neointimal tissue proliferation in human coronary arteries; an intravascular ultrasound study Eur. Heart J., November 1, 2001; 22(21): 2007 - 2014. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Kastrati, A. Schomig, J. Dirschinger, J. Mehilli, N. von Welser, J. Pache, H. Schuhlen, T. Schilling, C. Schmitt, and F.-J. Neumann Increased Risk of Restenosis After Placement of Gold-Coated Stents : Results of a Randomized Trial Comparing Gold-Coated With Uncoated Steel Stents in Patients With Coronary Artery Disease Circulation, May 30, 2000; 101(21): 2478 - 2483. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Gyongyosi, P. Yang, A. Khorsand, D. Glogar, on behalf of the Austrian Wiktor Stent Study Group, and European Paragon Stent Investigators Longitudinal straightening effect of stents is an additional predictor for major adverse cardiac events J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1580 - 1589. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y.-f. Cheung, S. Sanatani, M. P. Leung, D. G. Human, A. K. T. Chau, and J. A. G. Culham Early and intermediate-term complications of self-expanding stents limit its potential application in children with congenital heart disease J. Am. Coll. Cardiol., March 15, 2000; 35(4): 1007 - 1015. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Garasic, E. R. Edelman, J. C. Squire, P. Seifert, M. S. Williams, and C. Rogers Stent and Artery Geometry Determine Intimal Thickening Independent of Arterial Injury Circulation, February 22, 2000; 101(7): 812 - 818. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Escaned, J. Goicolea, F. Alfonso, M. J. Perez-Vizcayno, R. Hernandez, A. Fernandez-Ortiz, C. Banuelos, and C. Macaya Propensity and mechanisms of restenosis in different coronary stent designs: Complementary value of the analysis of the luminal gain-loss relationship J. Am. Coll. Cardiol., November 1, 1999; 34(5): 1490 - 1497. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. R. Edelman and C. Rogers Stent-Versus-Stent Equivalency Trials : Are Some Stents More Equal Than Others? Circulation, August 31, 1999; 100(9): 896 - 898. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Rogers, D. Y. Tseng, J. C. Squire, and E. R. Edelman Balloon-Artery Interactions During Stent Placement : A Finite Element Analysis Approach to Pressure, Compliance, and Stent Design as Contributors to Vascular Injury Circ. Res., March 5, 1999; 84(4): 378 - 383. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. J. Topol and P. W. Serruys Frontiers in Interventional Cardiology Circulation, October 27, 1998; 98(17): 1802 - 1820. [Full Text] [PDF]
|
|
|
|
|
|
O. F. Bertrand, R. Sipehia, R. Mongrain, J. Rodes, J.-C. Tardif, L. Bilodeau, G. Cote, and M. G. Bourassa Biocompatibility aspects of new stent technology J. Am. Coll. Cardiol., September 1, 1998; 32(3): 562 - 571. [Abstract] [Full Text] [PDF]
|
|