ABSTRACT
PURPOSE: To evaluate the development of neointimal hyperplasia after implantation of drug-eluting stents (paclitaxel) compared to bare metal stents in porcine internal carotid arteries (ICAs). METHODS: While drug-eluting stents have effectively reduced neointimal proliferation in porcine external carotid arteries, the porcine internal carotid artery (ICA) is more sensitive to shear stress and altered flow conditions. Thus, a study was conducted to evaluate bare vs. drug-eluting stents in porcine ICAs. Under general anesthesia, 18 domestic pigs were implanted with paclitaxel-eluting (n = 18) and bare (n = 18) stents in the left and right ICAs, respectively. After 1 and 3 months, control carotid angiography was performed, followed by histopathological and histomorphometric analyses of the stented ICA. RESULTS: Histopathological results (fibrin deposition, necrosis, inflammation) were similar in the groups at 1 and 3 months. Moreover, the injury score and rate of endothelialization did not differ between the groups. Histomorphometric analysis after 1 month revealed significantly (p<0.05) less neointimal hyperplasia after implantation of paclitaxel-eluting stents. The antiproliferative effect of paclitaxel-eluting stents were maintained during the 3-month follow-up: the neointimal area was 0.7 ± 0.5 vs. 1.2 ± 0.6 mm(2) (p<0.01), the area stenosis was 23.5% ± 13.9% vs. 37.8% ± 14.4% (p<0.01), the maximal neointimal thickness was 0.2 ± 0.1 vs. 0.2 ± 0.9 mm (p<0.05) in paclitaxel-eluting vs. bare stents, respectively. Implantation of paclitaxel-eluting and bare stents did not lead to edge restenosis or vessel remodeling in porcine ICAs at 1 or 3 months. CONCLUSION: Compared to bare metal stents, drug-eluting stents implanted in the porcine ICA produced significantly less neointimal hyperplasia.
Subject(s)
Angioplasty, Balloon/instrumentation , Cardiovascular Agents/administration & dosage , Carotid Artery, Internal/pathology , Carotid Stenosis/prevention & control , Drug-Eluting Stents , Metals , Paclitaxel/administration & dosage , Stents , Tunica Intima/pathology , Angioplasty, Balloon/adverse effects , Animals , Carotid Artery, Internal/diagnostic imaging , Carotid Stenosis/etiology , Carotid Stenosis/pathology , Cell Proliferation , Hyperplasia , Platelet Aggregation Inhibitors/administration & dosage , Prosthesis Design , Radiography , Sus scrofa , Time Factors , Tunica Intima/diagnostic imagingABSTRACT
PURPOSE: To report a complication of stent placement at a bifurcation in the infrapopliteal arteries. CASE REPORT: A 60-year-old man presented with a complex subtotal stenosis in the anterior tibial artery and the tibioperoneal trunk. Two drug-eluting stents were implanted by means of the crush technique, successfully recanalizing the trifurcation. One week later, the patient was readmitted with a thrombotic occlusion of the popliteal artery. Fluoroscopy showed a fracture of the larger stent in the tibioperoneal trunk. After successful local thrombolysis, a stent fragment was located in the popliteal artery and removed with an Amplatz snare. Long-term follow-up was uneventful. CONCLUSION: Fracture may be a more common complication of bifurcation stenting when undertaken in a territory at high risk for this complication.
Subject(s)
Angioplasty, Balloon/adverse effects , Arterial Occlusive Diseases/therapy , Foreign-Body Migration/etiology , Popliteal Artery , Prosthesis Failure , Stents , Thrombosis/etiology , Tibial Arteries , Angioplasty, Balloon/methods , Arterial Occlusive Diseases/diagnostic imaging , Constriction, Pathologic/surgery , Foreign-Body Migration/diagnostic imaging , Humans , Male , Middle Aged , Popliteal Artery/diagnostic imaging , Radiography, Interventional , Thrombosis/diagnostic imaging , Tibial Arteries/diagnostic imaging , Ultrasonography, Doppler, DuplexABSTRACT
BACKGROUND: The moderate increase in postprandial plasma glucose in subjects with impaired glucose tolerance has been shown to be a predictor of cardiovascular disease. In the randomised STOP-NIDDM trial, we could demonstrate that lowering postprandial plasma glucose with acarbose in subjects with impaired oral glucose tolerance could reduce the risk of diabetes. METHODS: The current report focuses on the effect of acarbose on silent ischaemic events evaluated in the electrocardiographic substudy, using the Minnesota code classification. RESULTS: A total of 1181 patients were included in the ECG substudy. From these 72 patients had significant changes between the baseline and end of treatment ECG, 33 in the acarbose and 39 in the placebo group. Higher rates of myocardial infarctions occurred in the placebo group (P=0.07 with Fisher's Exact test and P=0.023 with Chi-square test), while there were no differences between the two groups with ECG changes classified under the other Minnesota codes. CONCLUSIONS: In this prospective intervention study we could show that acarbose, by decreasing postprandial hyperglycaemia, can reduce the incidence of silent myocardial infarctions in subjects with impaired glucose tolerance. This approach should therefore be evaluated in other higher risk populations.
