Chronic vascular response after self-expanding nitinol stent implantation in superficial femoral arteries: a serial intr
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ORIGINAL ARTICLE
Chronic vascular response after self-expanding nitinol stent implantation in superficial femoral arteries: a serial intravascular ultrasound analysis Machiko Nishimura1 • Kenichi Fujii1 • Masashi Fukunaga1 • Daizo Kawasaki2 • Kojiro Miki1 • Ten Saita1 • Tetsuo Horimatsu1 • Hiroto Tamaru1 • Takahiro Imanaka1 Yoshiro Naito1 • Tohru Masuyama1
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Received: 25 June 2015 / Accepted: 23 November 2015 Japanese Association of Cardiovascular Intervention and Therapeutics 2015
Abstract The mechanical properties of the self-expanding nitinol stents (SENS) and chronic biological stimulation on the wall from the SENS have not been fully investigated. This study evaluated the mechanical vascular response to SENS implantation in superficial femoral artery (SFA) lesions using serial volumetric intravascular ultrasound (IVUS). Twenty-five symptomatic patients due to de novo SFA lesions scheduled for SENS placement were prospectively enrolled. Serial IVUS studies were performed immediately after crossing with a guidewire, immediately after the procedure, and at a 8-month followup. Serial IVUS volumetric analysis was conducted after stent deployment and at follow-up. Mean stent, lumen and neointimal areas were calculated as the volume divided by the stent length, and the calcium arc was measured. At follow-up, SENS had increased 40.6 % in overall volume. The chronic stent expansion tended to be larger, and the mean neointimal area at the 8-month follow-up was significantly larger in less calcified lesions compared to heavily calcified lesions. As a result, the mean late lumen area loss was significantly larger in lesions with calcium arcs of 0 and in the first and second quadrants than in those with calcium arcs in the third and fourth quadrants (2.8 ± 7.2, 1.3 ± 5.6, 0.6 ± 5.9, 1.2 ± 5.4, -0.8 ± 5.2 mm2, respectively; p \ 0.001). SENSs continued to enlarge with intimal proliferation over 8 months in all lesions. Although arterial calcium affected the degree of
& Kenichi Fujii [email protected] 1
Cardiovascular Division, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 6638501, Japan
2
Cardiovascular Division, Morinomiya Hospital, Osaka, Japan
chronic stent expansion during the follow-up period, neointimal proliferation was smaller in heavily calcified lesion compared to less calcified lesion following SENS implantation. Keywords Intravascular ultrasound Self-expanding nitonol stent Superficial femoral artery
Introduction Endovascular therapy (EVT) has been accepted widely as a minimally invasive treatment for patients with peripheral artery disease (PAD) because of its effectiveness and the development of techniques and devices [1–3]. In the intermediate term, the strategy of treating superficial femoral artery (SFA) lesions by the primary placement of self-expanding nitinol stents (SENS) was superior to that of using balloon angioplasty with optional secondary stenting [4]. Although the initial success rate for EVT for SFA lesions had been reported to be 95 % for stenotic lesions an
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