Objective To determine if an aggressive approach to coronary revascularization with oversized balloons is counterproductive, we studied the effect of increasing balloon-to-artery (B:A) ratio on neointimal hyperplasia following primary stent placement using a nonatherosclerotic porcine coronary overstretch model.
Methods Sixty vessels in 33 Yorkshire swine were randomly assigned to one of five B:A ratios between 1.0:1 and 1.4:1. Intravascular ultrasound (IVUS) imaging was performed before bare-metal stent placement to accurately determine vessel size, after stent placement, and at 28 days.
Results The mean prestent vessel diameter was 3.05±0.31 (SD) mm. In-stent neointimal volume, in-stent volume stenosis, and cross-sectional area stenosis at the stent minimum lumen diameter increased significantly with increasing achieved B:A ratio (multilevel regression test for slope, p < 0.001, p = 0.002, and p < 0.001, respectively) and were independent of vessel size. Even minor vessel overstretch at an achieved B:A ratio of 1.1:1 resulted in significant neointimal hyperplasia. Larger B:A ratios were also associated with more neointima beyond the stent edges (p = 0.008). For vessels from the same animal, neointimal response at a given B:A ratio was dependent upon the animal treated.
Conclusions In a porcine model of IVUS-guided coronary primary stent placement, vessel overexpansion is counterproductive. Neointimal hyperplasia at 28 days is strongly associated with increasing B:A ratio. In addition, vessels do not respond independently of each other when multiple stents are placed within the same animal using a range of B:A ratios.
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