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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 23:121-127, January 2002
© 2002 American Society of Neuroradiology

INTERVENTIONAL

Oversizing of Self-Expanding Stents: Influence on the Development of Neointimal Hyperplasia of the Carotid Artery in a Canine Model

Eberhard C. Kirsch^a,b, Mark S. Khangure^b, Philip Morling^c, Terry J. York^d and William McAuliffe^b

^a Department of Neuroradiology, University Hospital Basel, Switzerland
^b Interventional Neuroradiology Unit, Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Australia
^c Department of Neuropathology, Royal Perth Hospital, Australia
^d Research Centre, Royal Perth Hospital, Australia

Address reprint requests to Eberhard C. Kirsch, MD, Neuroradiology, Department of Diagnostic Radiology, University Hospital Basel, Petersgraben 4, CH - 4031 Basel, Switzerland

BACKGROUND AND PURPOSE: In carotid artery stent placement, marked oversizing of the stent relative to the internal carotid artery lumen is common. This study was performed to determine the influence of using oversized self-expanding nitinol stents on neointimal hyperplasia.

METHODS: In six greyhound dogs, 24 self-expanding nitinol stents (eight SMART stents, eight Easy Wallstents, eight Sinus-Flex stents) were inserted into both common carotid arteries (CCAs). In each CCA, two stents were deployed; a stent of the appropriate diameter was implanted distally and an oversized stent proximally. After 4 months, transverse sections of each stent were examined histologically and at computerized image analysis. Neointimal hyperplasia was determined as the proportion of the residual diameter of the patent vessel lumen compared with the stent lumen.

RESULTS: The amount of neointimal hyperplasia did not differ between the normal-sized and oversized stents. The mean preserved luminal diameter (± SEM) with normal- and oversized stents, respectively, were as follows: Easy Wallstent, 94% ± 1.0 and 96% ± 1.5; SMART stent, 92% ± 1.6 and 93% ± 1.8; and Sinus-Flex stent, 93% ± 2.7 and 93% ± 2.6. The mean preserved patent lumen with the 12 normal-sized stents (93% ± 1.0) was not significantly different from that of the 12 oversized stents (94% ± 1.1, P = .502).

CONCLUSION: Under experimental conditions, use of self-expanding stents oversized by 30–40% appeared to result in neointimal hyperplasia comparable to that caused by normal-sized stents. All three stent types appeared to have similarly low neointimal responses.

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