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Fracture in drug‐eluting stents increases focal intimal hyperplasia in the atherosclerosed rabbit iliac artery
Author(s) -
Conway Claire,
Desany Gerard J.,
Bailey Lynn R.,
Keating John H.,
Baker Brian L.,
Edelman Elazer R.
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27726
Subject(s) - medicine , neointimal hyperplasia , restenosis , stent , lumen (anatomy) , intimal hyperplasia , paclitaxel , urology , everolimus , artery , sirolimus , cardiology , drug eluting stent , chemotherapy , smooth muscle
Abstract Objectives Drug‐eluting stent (DES) strut fracture (SF) is associated with higher incidence of In‐stent restenosis (ISR)—return of blockage in a diseased artery post stenting—than seen with bare metal stents (BMS). We hypothesize that concomitance of drug and SF leads to greater neointimal response. Background Controlled release of therapeutic agents, such as sirolimus and its analogs, or paclitaxel from has reduced tissue based DES failure modes compared to BMS. ISR is dramatically reduced and yet the implications of mechanical device failure is magnified. Methods Bilateral Xience Everolimus‐eluting stents (EES) were implanted in 20 New Zealand White rabbits on normal ( n = 7) or high fat (HF)/high cholesterol (HC) ( n = 13) diets. Implanted stents were intact or mechanically fractured. Everolimus concentration was as packaged or pre‐eluted. After 21 days, stented vessels were explanted, resin embedded, MicroCT scanned, and analyzed histomorphometrically. Results Fractured EES were associated with significant ( P < 0.05) increases in arterial stenosis and neointimal formation and lower lumen‐to‐artery area ratios compared to intact EES. Hyperlipidemic animals receiving pre‐eluted EES revealed no significant difference between intact and fracture groups. Conclusions SF increases intimal hyperplasia, post EES implant, and worse with more advanced disease. Pre‐eluted groups, reflective of BMS, did not show significant differences, suggesting a synergistic effect of everolimus and mechanical injury, potentially explaining the lack of SF reports for BMS. Here, we report that ISR has a higher incidence with SF in EES, the clinical implication is that patients with SF after DES implantation merit careful follow‐up.