Impact of chronic outward force on arterial responses of proximal and distal of long superficial femoral artery stent
Abstract Background Self-expanding nitinol stent (SENS) implantation is commonly oversized in the superficial femoral artery (SFA), and leads to chronic outward force (COF) and in-stent restenosis (ISR). This study aimed to investigate the impact of COF of oversizing SENS on ISR of SFA. Methods In p...
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doaj-fd46d36a7a0a42d7abe1af2cbdb6797d2021-07-04T11:06:13ZengBMCBMC Cardiovascular Disorders1471-22612021-06-012111810.1186/s12872-021-02141-zImpact of chronic outward force on arterial responses of proximal and distal of long superficial femoral artery stentHu Li0Seung-Woon Rha1Byoung Geol Choi2Se Yeon Choi3Sang Ki Moon4Won Young Jang5Woohyeun Kim6Ji Hun Ahn7Sang-Ho Park8Woong Gil Choi9Rui Feng Yang10Wen Wei Bai11Cheol Ung Choi12Yang gi Ryu13Man Jong Baek14Dong Joo Oh15Department of Medicine, The Second Affiliated Hospital of Kunming Medical UniversityCardiovascular Center, Korea University Guro HospitalCardiovascular Center, Korea University Guro HospitalCardiovascular Center, Korea University Guro HospitalCardiovascular Center, Korea University Guro HospitalCardiovascular Center, Korea University Guro HospitalCardiovascular Center, Korea University Guro HospitalDepartment of Cardiology, Soon Chun Hyang University Gumi HospitalDepartment of Cardiology, Soonchunhyang University Cheonan Hospital KoreaDepartment of Internal Medicine, School of Medicine, Konkuk UniversityDepartment of Medicine, The Second Affiliated Hospital of Kunming Medical UniversityDepartment of Medicine, The Second Affiliated Hospital of Kunming Medical UniversityCardiovascular Center, Korea University Guro HospitalCardiovascular Center, Korea University Guro HospitalCardiovascular Center, Korea University Guro HospitalCardiovascular Center, Korea University Guro HospitalAbstract Background Self-expanding nitinol stent (SENS) implantation is commonly oversized in the superficial femoral artery (SFA), and leads to chronic outward force (COF) and in-stent restenosis (ISR). This study aimed to investigate the impact of COF of oversizing SENS on ISR of SFA. Methods In patients with implanted SENS in SFA, intimal hyperplasia especially between proximal segment and distal segment was evaluated by quantitative angiography, and the impact of COF on mid-term angiographic outcomes was investigated. In addition, porcine model with implanted SENS was used to evaluate the impact of COF on angiographic and histopathologic outcomes at 1 month. Excised stented arteries were evaluated by histopathologic analysis. Results We analyzed 65 SENS in 61 patients with follow-up angiography at 6 months to 1 year. The baseline diameter was 6.8 ± 0.71 mm and length were 97.0 ± 33.8 mm for the SENS. The ratio of the diameter of the stent to the reference vessel was 1.3 ± 0.24 at the proximal portion and 1.53 ± 0.27 at the distal portion (P < 0.001). In the long SFA stent, stent-to-vessel ratio was significantly higher in the distal stent than in the proximal stent (1.3 ± 0.2 vs. 1.55 ± 0.25, P = 0.001). ISR incidence was higher at the distal stent (37.3% vs 52.6%, P = 0.029). All 11 pigs survived for 4 weeks after SENS implantation. The vessel diameter was 4.04 ± 0.40 mm (control group) vs 4.45 ± 0.63 mm (oversized group), and the implanted stent diameter was 5.27 ± 0.46 mm vs. 7.18 ± 0.4 mm (P = 0.001). The stent-to-vessel diameter ratio was 1.31 ± 0.12 versus 1.63 ± 0.20 (P < 0.001). After 4 weeks, restenosis % was 29.5 ± 12.9% versus 46.8 ± 21.5% (P = 0.016). The neointimal area was 5.37 ± 1.15 mm2 vs. 8.53 ± 5.18 mm2 (P = 0.05). The restenosis % was 39.34 ± 8.53% versus 63.97 ± 17.1% (P = 0.001). Conclusions COF is an important cause of restenosis in the distal portion of the SFA stent. Optimal sizing of the SFA stent is important to reduce the incidence of restenosis. Therefore, COF was an important factor of restenosis following distal SFA stenting.https://doi.org/10.1186/s12872-021-02141-zChronic outward forceSuperficial femoral arterySelf-expanding nitinol stentsStent oversizingHistomorphometry |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hu Li Seung-Woon Rha Byoung Geol Choi Se Yeon Choi Sang Ki Moon Won Young Jang Woohyeun Kim Ji Hun Ahn Sang-Ho Park Woong Gil Choi Rui Feng Yang Wen Wei Bai Cheol Ung Choi Yang gi Ryu Man Jong Baek Dong Joo Oh |
spellingShingle |
Hu Li Seung-Woon Rha Byoung Geol Choi Se Yeon Choi Sang Ki Moon Won Young Jang Woohyeun Kim Ji Hun Ahn Sang-Ho Park Woong Gil Choi Rui Feng Yang Wen Wei Bai Cheol Ung Choi Yang gi Ryu Man Jong Baek Dong Joo Oh Impact of chronic outward force on arterial responses of proximal and distal of long superficial femoral artery stent BMC Cardiovascular Disorders Chronic outward force Superficial femoral artery Self-expanding nitinol stents Stent oversizing Histomorphometry |
author_facet |
Hu Li Seung-Woon Rha Byoung Geol Choi Se Yeon Choi Sang Ki Moon Won Young Jang Woohyeun Kim Ji Hun Ahn Sang-Ho Park Woong Gil Choi Rui Feng Yang Wen Wei Bai Cheol Ung Choi Yang gi Ryu Man Jong Baek Dong Joo Oh |
author_sort |
Hu Li |
title |
Impact of chronic outward force on arterial responses of proximal and distal of long superficial femoral artery stent |
title_short |
Impact of chronic outward force on arterial responses of proximal and distal of long superficial femoral artery stent |
title_full |
Impact of chronic outward force on arterial responses of proximal and distal of long superficial femoral artery stent |
title_fullStr |
Impact of chronic outward force on arterial responses of proximal and distal of long superficial femoral artery stent |
title_full_unstemmed |
Impact of chronic outward force on arterial responses of proximal and distal of long superficial femoral artery stent |
title_sort |
impact of chronic outward force on arterial responses of proximal and distal of long superficial femoral artery stent |
publisher |
BMC |
series |
BMC Cardiovascular Disorders |
issn |
1471-2261 |
publishDate |
2021-06-01 |
description |
Abstract Background Self-expanding nitinol stent (SENS) implantation is commonly oversized in the superficial femoral artery (SFA), and leads to chronic outward force (COF) and in-stent restenosis (ISR). This study aimed to investigate the impact of COF of oversizing SENS on ISR of SFA. Methods In patients with implanted SENS in SFA, intimal hyperplasia especially between proximal segment and distal segment was evaluated by quantitative angiography, and the impact of COF on mid-term angiographic outcomes was investigated. In addition, porcine model with implanted SENS was used to evaluate the impact of COF on angiographic and histopathologic outcomes at 1 month. Excised stented arteries were evaluated by histopathologic analysis. Results We analyzed 65 SENS in 61 patients with follow-up angiography at 6 months to 1 year. The baseline diameter was 6.8 ± 0.71 mm and length were 97.0 ± 33.8 mm for the SENS. The ratio of the diameter of the stent to the reference vessel was 1.3 ± 0.24 at the proximal portion and 1.53 ± 0.27 at the distal portion (P < 0.001). In the long SFA stent, stent-to-vessel ratio was significantly higher in the distal stent than in the proximal stent (1.3 ± 0.2 vs. 1.55 ± 0.25, P = 0.001). ISR incidence was higher at the distal stent (37.3% vs 52.6%, P = 0.029). All 11 pigs survived for 4 weeks after SENS implantation. The vessel diameter was 4.04 ± 0.40 mm (control group) vs 4.45 ± 0.63 mm (oversized group), and the implanted stent diameter was 5.27 ± 0.46 mm vs. 7.18 ± 0.4 mm (P = 0.001). The stent-to-vessel diameter ratio was 1.31 ± 0.12 versus 1.63 ± 0.20 (P < 0.001). After 4 weeks, restenosis % was 29.5 ± 12.9% versus 46.8 ± 21.5% (P = 0.016). The neointimal area was 5.37 ± 1.15 mm2 vs. 8.53 ± 5.18 mm2 (P = 0.05). The restenosis % was 39.34 ± 8.53% versus 63.97 ± 17.1% (P = 0.001). Conclusions COF is an important cause of restenosis in the distal portion of the SFA stent. Optimal sizing of the SFA stent is important to reduce the incidence of restenosis. Therefore, COF was an important factor of restenosis following distal SFA stenting. |
topic |
Chronic outward force Superficial femoral artery Self-expanding nitinol stents Stent oversizing Histomorphometry |
url |
https://doi.org/10.1186/s12872-021-02141-z |
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