(Circulation. 1996;94:1741-1745.)
© 1996 American Heart Association, Inc.
Articles |
Influence of External Stent Size on Early Medial and Neointimal Thickening in a Pig Model of Saphenous Vein Bypass Grafting
the Bristol Heart Institute (M.B.I., D.M., A.J.B., A.C.N., G.D.A.) and Research and Development Support Unit (B.R.), University of Bristol, Bristol, UK.
Correspondence to Prof Dr G.D. Angelini, British Heart Foundation, Professor of Cardiac Surgery, Bristol Royal Infirmary, Bristol BS2 8HW, UK.
Background Late saphenous vein graft failure results from intimal and medial thickening due to migration and proliferation of vascular smooth muscle cells and superimposed atheroma. These changes may represent an adaptation by the vein to its insertion into the arterial system. Using a porcine model of arteriovenous bypass grafting, we recently demonstrated that supporting the graft with a nonrestrictive external Dacron velour stent significantly reduced intimal hyperplasia and total wall thickness. In the present study, we investigated the influence of different external stent sizes on graft wall dimensions and cell proliferation.
Methods and Results Three stent sizes were tested: mildly restrictive, nonrestrictive, and oversized (5, 6, and 8 mm in diameter, respectively). Four weeks after grafting, total wall thickness was decreased 40% by 5-mm stents (P=.02), 66% by 6-mm stents (P=.0004), and 81% by 8-mm stents (P=.02 versus unstented grafts). Neointimal thickness was reduced almost 62% by 6-mm and 72% by 8-mm stents (both P=.01) but not by 5-mm stents. As a result, the encroachment of the intima into the lumen was reduced 
70% by 6- or 8-mm stents (P=.02 and P=.01 versus unstented grafts, respectively). Both neointimal and medial cell proliferation were significantly reduced by all three stents compared with unstented grafts.
Conclusions External stenting of saphenous vein bypass grafts reduces early intimal and medial hyperplasia. Oversized stents give equally profound suppression of intimal thickening, obviating the need for precise size matching with the graft and greatly simplifying the surgical procedure.
Key Words: coronary disease • veins • grafts
This article has been cited by other articles:
 |
|
 |
|
  L. C.H. John Biomechanics of Coronary Artery and Bypass Graft Disease: Potential New Approaches Ann. Thorac. Surg., January 1, 2009; 87(1): 331 - 338. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Zilla, P. Human, M. Wolf, W. Lichtenberg, N. Rafiee, D. Bezuidenhout, N. Samodien, C. Schmidt, and T. Franz Constrictive external nitinol meshes inhibit vein graft intimal hyperplasia in nonhuman primates J. Thorac. Cardiovasc. Surg., September 1, 2008; 136(3): 717 - 725. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. J. Murphy, T. W. Johnson, M. H. Chamberlain, S. I. Rizvi, M. Wyatt, S. J. George, G. D. Angelini, K. R. Karsch, M. Oberhoff, and A. C. Newby Short- and long-term effects of cytochalasin D, paclitaxel and rapamycin on wall thickening in experimental porcine vein grafts Cardiovasc Res, February 1, 2007; 73(3): 607 - 617. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Fogelstrand, K. Osterberg, and E. Mattsson Reduced neointima in vein grafts following a blockage of cell recruitment from the vein and the surrounding tissue Cardiovasc Res, August 1, 2005; 67(2): 326 - 332. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Y. Jeremy, R. Bulbulia, J. L. Johnson, P. Gadsdon, V. Vijayan, N. Shukla, F. C. T. Smith, and G. D. Angelini A bioabsorbable (polyglactin), nonrestrictive, external sheath inhibits porcine saphenous vein graft thickening J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1766 - 1772. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. T. Higashida, P. M. Meyers, C. C. Phatouros, J. J. Connors III, J. D. Barr, D. Sacks, and for the Technology Assessment Committees of the Am Reporting Standards for Carotid Artery Angioplasty and Stent Placement Stroke, May 1, 2004; 35(5): e112 - e134. [Full Text] [PDF]
|
|
|
|
 |
|
 S. R. Lentz Thrombosis of Vein Grafts: Wall Tension Restrains Thrombomodulin Expression Circ. Res., January 10, 2003; 92(1): 12 - 13. [Full Text] [PDF]
|
|
|
|
|
|
G. D. Angelini, C. Lloyd, R. Bush, J. Johnson, and A. C. Newby An external, oversized, porous polyester stent reduces vein graft neointima formation, cholesterol concentration, and vascular cell adhesion molecule 1 expression in cholesterol-fed pigs J. Thorac. Cardiovasc. Surg., November 1, 2002; 124(5): 950 - 956. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. H. Shuhaiber, A. N. Evans, M. G. Massad, and A. S. Geha Mechanisms and future directions for prevention of vein graft failure in coronary bypass surgery Eur. J. Cardiothorac. Surg., September 1, 2002; 22(3): 387 - 396. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.H.P. Lardenoye, M.R. de Vries, J.M. Grimbergen, L.M. Havekes, M.W.M. Knaapen, M.M. Kockx, V.W.M. van Hinsbergh, J.H. van Bockel, and P.H.A. Quax Inhibition of Accelerated Atherosclerosis in Vein Grafts by Placement of External Stent in ApoE*3-Leiden Transgenic Mice Arterioscler Thromb Vasc Biol, September 1, 2002; 22(9): 1433 - 1438. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. C. Kirsch, M. S. Khangure, P. Morling, T. J. York, and W. McAuliffe Oversizing of Self-Expanding Stents: Influence on the Development of Neointimal Hyperplasia of the Carotid Artery in a Canine Model AJNR Am. J. Neuroradiol., January 1, 2002; 23(1): 121 - 127. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. McGregor, M. Gosling, D. K Beattie, D. M.P Ribbons, A. H Davies, and J. T Powell Circumferential stretching of saphenous vein smooth muscle enhances vasoconstrictor responses by Rho kinase-dependent pathways Cardiovasc Res, January 1, 2002; 53(1): 219 - 226. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Stooker, H. W. M. Niessen, A. Baidoshvili, W. R. Wildevuur, V. W. M. Van Hinsbergh, J. Fritz, C. R. H. Wildevuur, and L. Eijsman Perivenous support reduces early changes in human vein grafts: Studies in whole blood perfused human vein segments J. Thorac. Cardiovasc. Surg., February 1, 2001; 121(2): 0290 - 297. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. C. Phatouros, R. T. Higashida, A. M. Malek, P. M. Meyers, T. E. Lempert, C. F. Dowd, and V. V. Halbach Carotid Artery Stent Placement for Atherosclerotic Disease: Rationale, Technique, and Current Status Radiology, October 1, 2000; 217(1): 26 - 41. [Abstract] [Full Text]
|
|
|
|
|
|
S. Q. Liu Focal Expression of Angiotensin II Type 1 Receptor and Smooth Muscle Cell Proliferation in the Neointima of Experimental Vein Grafts : Relation to Eddy Blood Flow Arterioscler Thromb Vasc Biol, November 1, 1999; 19(11): 2630 - 2639. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Southgate, D. Mehta, M. B. Izzat, A. C. Newby, and G. D. Angelini Increased Secretion of Basement Membrane–Degrading Metalloproteinases in Pig Saphenous Vein Into Carotid Artery Interposition Grafts Arterioscler Thromb Vasc Biol, July 1, 1999; 19(7): 1640 - 1649. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D P DE BONO Olovnikov's clock: telomeres and vascular biology Heart, August 1, 1998; 80(2): 110 - 111. [Full Text]
|
|
|
|
 |
|
 J. G. Motwani and E. J. Topol Aortocoronary Saphenous Vein Graft Disease : Pathogenesis, Predisposition, and Prevention Circulation, March 10, 1998; 97(9): 916 - 931. [Abstract] [Full Text] [PDF]
|
|