Objective: To determine if an aggressive approach to coronary revascularisation 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 non-atherosclerotic porcine coronary overstretch model.
Methods: 60 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.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Competing interests: None.
Funding: This study was funded by grants from the Skaggs Clinical Scholars Program in Translational Research at The Scripps Research Institute, La Jolla, CA, USA; the Hewitt Foundation for Medical Research, Irvine, CA, USA; and The Vascular Surgery Foundation of San Diego, La Jolla, CA, USA. During the course of this work, M.Y. was an Established Investigator of the American Heart Association and a recipient of a Clinical Scientist Award in Translational Research from the Burroughs Wellcome Fund. The authors thank Boston Scientific/SCIMED for supplying coronary stents and intravascular ultrasound catheters, and Cordis Corporation for providing custom coronary guide catheters. The funding sources had no involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
- B:A ratio
- balloon-to-artery ratio
- intravascular ultrasound