title: Stent linker effect in a porcine coronary restenosis model.
abstract: In this study, we aimed to evaluate the mechanical effects of different stent linker designs on in-stent restenosis in porcine coronary arteries. We fabricated stents with an open-cell structure composed of nine main cells and three linker structures in model 1 (I-type), model 2 (S-types) and model 3 (U-types)) as well as Model 4, which is similar to a commercial bare metal stent design. The stent cells were 70 mm thick and wide, with a common symmetrical wave pattern. As the radial force increased, the number of main cells increased and the length of linker decreased. Radial force was higher in model 1, with a linear I-linker, than in models with S- or U-linkers. The flexibility measured by three-point bending showed a force of 1.09 N in model 1, 0.35 N in model 2, 0.19 N in model 3, and 0.31 N in model 4. The recoil results were similar in all models except model 4 and were related to the shape of the main cells. The foreshortening results were related to linker shape, with the lowest foreshortening observed in model 3 (U-linker). Restenosis areas in the porcine restenosis model 4 weeks after implantation were 35.4 ± 8.39% (model 1), 30.4 ± 7.56% (model 2), 40.6 ± 9.87% (model 3) and 45.1 ± 12.33% (model 4). In-stent restenosis rates measured by intravascular ultrasound (IVUS) and micro-computed tomography (micro-CT) showed similar trends as percent area stenosis measured by micro-CT. Model 2, with optimized flexibility and radial force due to its S-linker, showed significantly reduced restenosis in the animal model compared to stents with different linker designs. These results suggest that the optimal stent structure has a minimum radial force for vascular support and maximum flexibility for vascular conformability. The importance of the effects of these differences in stent design and their potential relationship with restenosis remains to be determined.
authors: Department of Polymer Science and Engineering, Sunchon National University, 255 Jungang-ro, Sunchon, Jeonnam 540-742, Republic of Korea; Bioalpha Co. Ltd., Seongnam, Republic of Korea.
authors: Jun-Kyu
authors: JK
authors: Park
authors: Chonnam National University Research Institute of Medical Science, 42 Jebong-ro Donggu, Gwangju 501-757, Republic of Korea; Korea Cardiovascular Stent Institute of Chonnam National University, Gwangju, Republic of Korea.
authors: Kyung Seob
authors: KS
authors: Lim
authors: Chonnam National University Research Institute of Medical Science, 42 Jebong-ro Donggu, Gwangju 501-757, Republic of Korea; Korea Cardiovascular Stent Institute of Chonnam National University, Gwangju, Republic of Korea.
authors: In-Ho
authors: IH
authors: Bae
authors: Department of Polymer Science and Engineering, Sunchon National University, 255 Jungang-ro, Sunchon, Jeonnam 540-742, Republic of Korea.
authors: Joung-Pyo
authors: JP
authors: Nam
authors: Bioalpha Co. Ltd., Seongnam, Republic of Korea.
authors: Jae Hwa
authors: JH
authors: Cho
authors: Department of Polymer Science and Engineering, Sunchon National University, 255 Jungang-ro, Sunchon, Jeonnam 540-742, Republic of Korea.
authors: Changyong
authors: C
authors: Choi
authors: Department of Polymer Science and Engineering, Sunchon National University, 255 Jungang-ro, Sunchon, Jeonnam 540-742, Republic of Korea.
authors: Jae-Woon
authors: JW
authors: Nah
authors: Chonnam National University Research Institute of Medical Science, 42 Jebong-ro Donggu, Gwangju 501-757, Republic of Korea; Korea Cardiovascular Stent Institute of Chonnam National University, Gwangju, Republic of Korea. Electronic address: myungho@chollian.net.
authors: Myung Ho
authors: MH
authors: Jeong
mesh_terms: D000818:Animals; D023903:Coronary Restenosis / Q000473:pathology; D003331:Coronary Vessels; D004195:Disease Models, Animal; D055595:Mechanical Phenomena; D011474:Prosthesis Design; D012449:Safety; D015607:Stents / Q000009:adverse effects; D013552:Swine
keywords: Coronary stent; Linker; Percutaneous coronary intervention; Restenosis; Stent design