Polymeric stenting in the porcine coronary artery model: differential outcome of exogenous fibrin sleeves versus polyurethane-coated stents

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.

OBJECTIVES. In a porcine coronary model, fibrin film soaked for 3 h in heparin was used as a circumferential coating on a tantalum stent to assess the effect of this naturally occurring biopolymer on arterial healing. The results were compared with those obtained with medical grade polyurethane-coated stainless steel stents. BACKGROUND. Thrombus plays an important role in healing after arterial injury and may affect the development of neointimal hyperplasia. Manipulation of the initial thrombus may alter the healing response. To study this, we placed a template of fibrin in a porcine coronary artery restenosis model. METHODS. Thirty-four fibrin film stents were delivered in 20 swine. Oversizing was avoided, to prevent deep arterial injury, by placement of optimally sized stents. Initial patency of the stented vessel was confirmed by angiography. RESULTS. Three fibrin-stented swine died within 48 h; in each, the stent was occluded with a fibrin/red blood cell mass. In two of these three, a portion of the exogenous fibrin had become detached from the stent and partially occluded the lumen. Of the remaining 31 stents, all were patent at elective sacrifice at 28 days. Eighty-four percent had a diameter stenosis < 50%, and the mean (+/- SD) diameter stenosis was 32.3 +/- 13%. There was no evidence of significant foreign-body giant-cell reaction. These results contrasted with the medical grade polyurethane-coated stents placed according to the same protocol without oversizing. Twelve of these stents were placed; six swine died of thrombotic occlusion within the 1st 48 h. At elective sacrifice at 28 days, the remaining polyurethane-coated stents were occluded by marked neointimal hyperplasia. CONCLUSIONS. Fibrin film-coated stents seem promising as a template for modifying the local response to arterial injury and for potentially decreasing restenosis rates.

This article has been cited by other articles:

				J. H. Shin, H.-Y. Song, C. G. Choi, S. H. Yuk, J.-S. Kim, Y. M. Kim, C. J. Yoon, T.-H. Kim, J.-Y. Suh, and X. He Tissue Hyperplasia: Influence of a Paclitaxel-eluting Covered Stent--Preliminary Study in a Canine Urethral Model Radiology, February 1, 2005; 234(2): 438 - 444. [Abstract] [Full Text] [PDF]

				A. Kondyurin, V. Romanova, V. Begishev, I. Kondyurina, R. Guenzel, and M. F. Maitz Crosslinked Polyurethane Coating on Vascular Stents for Enhanced X-ray Contrast Journal of Bioactive and Compatible Polymers, January 1, 2005; 20(1): 77 - 93. [Abstract] [PDF]

				J. F.W. Keuren, S. J.H. Wielders, A. Driessen, M. Verhoeven, M. Hendriks, and T. Lindhout Covalently-Bound Heparin Makes Collagen Thromboresistant Arterioscler Thromb Vasc Biol, March 1, 2004; 24(3): 613 - 617. [Abstract] [Full Text]

				R. S. Schwartz, E. R. Edelman, A. Carter, N. Chronos, C. Rogers, K. A. Robinson, R. Waksman, J. Weinberger, R. L. Wilensky, D. N. Jensen, et al. Drug-Eluting Stents in Preclinical Studies: Recommended Evaluation From a Consensus Group Circulation, October 1, 2002; 106(14): 1867 - 1873. [Full Text] [PDF]

				E Regar, G Sianos, and P W Serruys Stent development and local drug delivery Br. Med. Bull., October 1, 2001; 59(1): 227 - 248. [Abstract] [Full Text] [PDF]

				S. M. Santilli, A. S. Tretinyak, and E. S. Lee Transarterial wall oxygen gradients at the deployment site of an intra-arterial stent in the rabbit Am J Physiol Heart Circ Physiol, October 1, 2000; 279(4): H1518 - H1525. [Abstract] [Full Text] [PDF]

				C Schulz, R A Herrmann, C Beilharz, J Pasquantonio, and E Alt Coronary stent symmetry and vascular injury determine experimental restenosis Heart, April 1, 2000; 83(4): 462 - 467. [Abstract] [Full Text]

				H. J. Cloft, D. F. Kallmes, H.-B. Lin, S.-T. Li, W. F. Marx, S. B. Hudson, G. A. Helm, M. B. Lopes, J. K. McGraw, J. E. Dion, et al. Bovine Type I Collagen as an Endovascular Stent-Graft Material: Biocompatibility Study in Rabbits Radiology, February 1, 2000; 214(2): 557 - 562. [Abstract] [Full Text]

				J Gunn and D Cumberland Stent coatings and local drug delivery. State of the art Eur. Heart J., December 1, 1999; 20(23): 1693 - 1700. [PDF]

				F. Schellhammer, M. Walter, A. Berlis, H.-G. Bloss, E. Wellens, and M. Schumacher Polyethylene Terephthalate and Polyurethane Coatings for Endovascular Stents: Preliminary Results in Canine Experimental Arteriovenous Fistulas Radiology, April 1, 1999; 211(1): 169 - 175. [Abstract] [Full Text]

				C. Stefanadis, K. Toutouzas, E. Tsiamis, C. Vlachopoulos, S. Vaina, D. Tsekoura, L. Haldi, E. Stefanadi, M. Gravanis, and P. Toutouzas Stents covered by an autologous arterial graft in porcine coronary arteries: feasibility, vascular injury and effect on neointimal hyperplasia Cardiovasc Res, February 1, 1999; 41(2): 433 - 442. [Abstract] [Full Text] [PDF]

				E. J. Topol and P. W. Serruys Frontiers in Interventional Cardiology Circulation, October 27, 1998; 98(17): 1802 - 1820. [Full Text] [PDF]

				O. F. Bertrand, R. Sipehia, R. Mongrain, J. Rodes, J.-C. Tardif, L. Bilodeau, G. Cote, and M. G. Bourassa Biocompatibility aspects of new stent technology J. Am. Coll. Cardiol., September 1, 1998; 32(3): 562 - 571. [Abstract] [Full Text] [PDF]

				T. A. Fischell Polymer Coatings for Stents: Can We Judge a Stent by Its Cover? Circulation, October 1, 1996; 94(7): 1494 - 1495. [Full Text]

				E. R. Edelman and C. Rogers Hoop Dreams: Stents Without Restenosis Circulation, September 15, 1996; 94(6): 1199 - 1202. [Full Text]