A comparison of four stent designs on arterial injury, cellular proliferation, neointima formation, and arterial dimensions in an experimental porcine model.

The stent-artery interactions of different stent designs have implications for their clinical effects. We studied four different stent designs to compare their effects on arterial injury, cellular proliferation, neointima formation, and arterial dimensions. Eighteen nonatherosclerotic miniswine underwent random placement of 52 coronary stents (3.0 mm), including self-expanding nitinol stents (no postdilation; Radius, n = 13) and balloon-expandable stents (8 atm x 45 sec; Palmaz-Schatz, n = 13; BX, n = 12; and Multilink, n = 14). Cellular proliferation was determined by S-phase labeling with BrdU at 7, 14, and 28 days. Proliferation, injury scores, and arterial morphometry were blindly evaluated. All four stent designs had similar injury scores, cellular proliferation indexes (neointimal and medial), and adventitial areas. Nitinol stents resulted in a twofold increase in neointimal area and thickness in 28-day vessels (P = 0.002). However, lumen area was similar for all stent designs because of an offsetting expansion in vessel area in nitinol stents (20% greater than balloon-expandable stents) occurring between 7 and 14 days after stent deployment (P = 0.03). Reduced neointimal cell density in nitinol stents (20% less than balloon-expandable stents, P = 0.012) suggests that extracellular matrix expansion accounts for the larger neointima in nitinol stents. Self-expansion of nitinol stents within normal porcine arteries results in a similar degree of arterial injury compared to balloon-expandable stent designs. Progressive enlargement of nitinol stents between 7 and 14 days after deployment is associated with the development of a larger, matrix-rich neointima, with a preserved lumen area. Cathet Cardiovasc Intervent 2001;53:420-425. Published 2001 Wiley-Liss, Inc.

The 90-day coronary vascular response to (90)Y-beta particle-emitting stents in the canine model.

PURPOSE: Long-term preclinical studies using continuous, low-dose-rate vascular brachytherapy with (32)P beta-emitting stents have yielded largely disappointing results. In contrast, a shorter half-life, higher dose-rate (90)Y beta-emitting stent more closely mimics the delivery dose rate characteristics of clinically effective beta- and gamma-wire and balloon brachytherapy devices. We evaluated the dose response characteristics of a (90)Y beta-emitting stent in the canine coronary injury model and hypothesized that this device would reduce neointimal formation. METHODS: Seventy-seven (90)Y beta-emitting coronary stents (15 mm BXTM, 3.0- and 3.5-mm diameter) were implanted in 26 normal dogs (20-25 kg) using a randomized, blinded study design. Stent activity included nonradioactive controls (n = 24), 4.5 microCi (n = 15), 8 microCi (n = 12), 16 microCi (n = 18), and 32 microCi (n = 8). Histologic endpoints were assessed at 3 months. RESULTS: Luminal stenosis and neointimal area were similar in control stents and low-activity (4.5 and 8 microCi) (90)Y stents. Higher activity stents (16 and 32 microCi) were associated with significant adverse effects. Frequent total occlusions (5 of 18 stents, 28%; p = 0.008) and a 40% increase in neointimal area (p = 0.024 vs. control) occurred in the 16 microCi group. Incomplete neointimal healing and a trend for reduced neointimal cell density were evident only in the 16- and 32-microCi group. CONCLUSION: Despite unique characteristics (2.7 day half-life and a higher dose rate) of (90)Y beta-emitting coronary stents, they have an adverse effect on neointimal formation, including frequent total occlusions at high activity levels. Incomplete healing, present 90 days (33 half-lives) after stent placement, indicates prolonged recovery from radiation injury.

Arrhythmogenic right ventricular cardiomyopathy and fatty replacement of the right ventricular myocardium: are they different diseases?

BACKGROUND: The relationship between arrhythmogenic right ventricular cardiomyopathy (ARVC) and pure fat replacement of the right ventricle is unclear. METHODS AND RESULTS: Myocardial thickness, epicardial fat thickness, percent fibrosis, and intramyocardial fat infiltration were measured in 16 sections each from 25 hearts with typical (fibrofatty) ARVC, 7 hearts with fat replacement of the right ventricle without fibrosis (FaRV), and 18 control hearts from patients who died of noncardiac causes. Patients with fibrofatty ARVC were younger than those with FaRV (31+/-14 versus 44+/-13 years, P=.02), more likely to have a history of arrhythmias or a family history of premature sudden death (56% versus 0%, P=.01), more likely male (80% versus 29%, P=.02), and less likely to have coexisting conditions that might have predisposed to sudden death (12% versus 86%, P<.001). Fibrofatty ARVC was characterized by right ventricular myocardial thinning, fat infiltration of the anterobasal and posterolateral apical right ventricle, subepicardial left ventricular fibrofatty replacements (64%), myocyte atrophy (96%), and lymphocytic myocarditis (80%). FaRV showed normal or increased myocardial thickness, a diffuse increase in intramyocardial and epicardial fat, little inflammation, and an absence of myocardial atrophy. Intramyocardial fat was frequently seen in normal hearts, especially in the anteroapical region, but was less extensive than in fibrofatty ARVC and FaRV. CONCLUSIONS: ARVC is a familial arrhythmogenic disease characterized by fibrofatty replacement of myocytes with scattered foci of inflammation. Fat infiltration per se is probably a different process that should not be considered synonymous with ARVC.