Compliance matching stent placement in the carotid artery of the swine promotes optimal blood flow and attenuates restenosis.
OBJECTIVE
We assessed the value of a gradient-compliant stent in an animal model.


METHODS
Bilateral carotid arteries were stented with nitinol stents having variable-oversizing, variable-stiffness, and with (CMS, 10 animals) and without (SMART, four animals) compliance-matching endings. Angiography, hemodynamic, scanning-electron-microscopic and histological analyses were performed at 3-month. The protocol was completed in 14 among 19 swines.


RESULTS
Transient (1-month) exaggerated recoil, attributable to stress-induced phasic inhibition of vasorelaxation, developed at CMS endings. At mid-term, all stents were endothelialized; CMS-stents, but not SMART-stents, were incorporated into walls (one-strut-thickness). Restenosis developed outside SMART-stents (cell migration+wall-compensatory enlargement) whereas CMS-stents elicited no or focalized cell-accumulations at endings that bulged vascular walls radially outward. SMART-stents were blood-flow neutral, whereas CMS-stents favored (higher-stiffness, higher-oversizing) or opposed (lower-stiffness, less-oversizing) carotid blood flow.


CONCLUSIONS
Direct carotid stenting with stents having compliance-matched endings and specific requirements of stiffness and oversizing can optimize blood flow to the brain and restrict local restenosis.
Rolland
P H
PH
Laboratory of Hemodynamics and Cardiovascular Mechanics, School of Medicine, Marseille, France. ph.rolland@medecine.univ-mrs.fr
Mekkaoui
C
C
Vidal
V
V
Berry
J L
JL
Moore
J E
JE
Moreno
M
M
Amabile
P
P
Bartoli
J M
JM
D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D019917:Blood Vessel Prosthesis Implantation; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D003187:Compliance; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000503:physiopathology; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D023421:Models, Animal; D008955:Models, Cardiovascular; D011673:Pulsatile Flow; D011859:Radiography; D012039:Regional Blood Flow / Q000502:physiology; D013223:Statistics as Topic; D015607:Stents; D013552:Swine; D013997:Time Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000503:physiopathology; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology