Original Research Article

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Journal of Structural Heart Disease, December 2017, Volume 3, Issue 6:165-175
DOI: 10.12945/j.jshd.2017.030.17

Intentional Fracture of Previously Placed Stents: Impact of Pre-stenting in a Piglet Model

András Bratincsák, MD, PhD1, William Van Alstine, DVM, PhD, DACVP3, Lindsay Koren, BE2, Kimberly Stoughton, CVT3, José Negrón-Garcia, CVT3, Anthony Ragheb, PhD2, Hannah El-Sabrout, HSDG4, John W. Moore, MD, MPH5, Howaida el-Said, MD, PhD5

1 Kapi'olani Medical Center for Women and Children, University of Hawaii, Honolulu, Hawaii, USA
2 Cook Medical, Bloomington, Indiana, USA
3 Cook Research Incorporated, West Lafayette, Indiana, USA
4 Department of Molecular, Cell and Developmental Biology, University of California, Los Angeles, California, USA
5 Rady Children's Hospital, University of California San Diego, San Diego, California, USA


Background: Intentional stent fracture in vivo induces medial dissection/vessel injury. Spontaneous stent fracture in humans can lead to stent collapse, hemodynamic compromise, and embolization of stent fragments, which could be prevented by pre-stenting. Objectives: To evaluate the short-term and mid-term effects of pre-stenting prior to intentional stent fracture on vessel size and integrity in a piglet model.

Methods: Five months after 14 low-profile stents (Cook Formula 418 stents) were implanted in the aorta of four piglets, they were intentionally fractured using ultra-high-pressure balloons with (pre-stent group) or without (single stent group) with another stent placed inside.

Results: Compared with the single stent group, the pre-stent group showed a significantly larger vessel lumen area (109 mm2 (89–141) vs. 57 mm2 (47–73), P = 0.019), less mid-term luminal diameter loss (44% (26–59) vs. 75% (62–85), P = 0.007), lack of strut protrusion, and improved endothelialization (100% (89–100) vs. 73% (56–96), P = 0.022). Vessel wall injury was similar between groups at the time of stent fracture; however, the injury score was significantly improved at mid-term in the pre-stent group compared with the single stent group (P = 0.046). No damage to the external part of the blood vessels or the surrounding soft tissue was noted in either group.

Conclusion: Pre-stenting before intentional stent fracture may provide advantages including larger vessel diameter, maintained vessel patency, more complete endothelialization, and lack of stent strut protrusion.


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Cite this article as: Bratincsák A, Van Alstine W, Koren L, Stoughton K, Negrón-Garcia J, Ragheb A, El-Sabrout H, Moore JW, el-Said H. Intentional Fracture of Previously Placed Stents: Impact of Pre-stenting in a Piglet Model. Structural Heart Disease 2017;3(6):165-175. DOI: 10.12945/j.jshd.2017.030.17

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