Morphometric analysis of the intimal reaction after stent implantation in iliac arteries submitted to angioplasty in pigs

Abstract

PURPOSE: To compare through digital morphometry, the intimal thickening of the common ilíac arteries (CIA) in pigs, submitted to angioplasty and angioplasty followed by stent implantation. METHODS: Angioplasty was performed in 10 pigs in both CIA, followed by a stent implantation in the left CIA. After four weeks, the aorto-iliac segment was dissected. Histologic slices where divided in three groups: left CIA in the area of the proximal (group 1) and distal (group 2) implantation site of the stent and the region of angioplasty in the right CIA (group 3). The histological slices were digitalized to be analyzed by morphometry with calculation of the luminal, intimal and media layers areas. Descriptive statistics analysis was performed through average and standard deviation of areas on each group, using ANOVA, with LSD Post-Hoc test (p<0.05). RESULTS: A significant statistic difference was observed when the median area of intimal layer of the groups 1 and 2 where compared with group 3 and in the media layer area of the groups 1 and 2 when compared with group 3. No difference was observed in luminal areas among the three groups. CONCLUSION: Angioplasty followed by stent insertion produces an intimal thickening larger than that observed after simple angioplasty. However, the area of the media layer is smaller in the "angioplasty plus stent" group and there is no significant change in the luminal area among the three groups.

Inflammatory Response Following Peripheral Endovascular Treatment Correlates with the Extent of Periprocedural Arterial Injury

“…Plasma CRP levels were found to be significantly higher in patients 48 hours following stent implantation compared to PTA group. These results can be correlated with morphometric studies ( 24 , 25 ) in porcine models where more intimal hyperplasia was found after stenting compared to balloon angioplasty, suggesting a more pronounced inflammatory response.…”

Effect of cilostazol on neointimal hyperplasia in iliac arteries of pigs after transluminal angioplasty

“…The experimental porcine model of balloon catheter angioplasty in coronary arteries could cause significant neointimal hyperplasia only when there was rupture of the internal elastic lamina 22 . In rat carotid arteries, the results are similar 23 . Previous work comparing versus angioplasty versus angioplasty with stent in pigs' iliac arteries concluded that the use of the stent causes increased neointimal hyperplasia 23 .…”

“…In rat carotid arteries, the results are similar 23 . Previous work comparing versus angioplasty versus angioplasty with stent in pigs' iliac arteries concluded that the use of the stent causes increased neointimal hyperplasia 23 . These previous studies have also applied the technique of multiple angioplasties aimed to cause greater damage to the arterial wall.…”

Análise morfométrica da carótida de suínos submetidos a angioplastia com ou sem implante de stent de cromo-cobalto

“…The hyperplasia secondary to angioplasty and cobalt-chromium stent placement does not appear to differ from that found after placement of devices made from 316L-grade stainless steel or nitinol in previous studies conducted in our experimental unit. Various studies conducted by Pasa et al, Grudtner et al, Dutra et al e Castro et al [21][22][23][24] have shown the role of angioplasty-and stent-induced vascular injury, regardless of alloy and coating, in the intimal hyperplasia process.…”

“…The authors found no difference between the study groups, but confirmed that all stents, coated or otherwise, are associated with significant formation of neointima. Castro et al 24 assessed the neointimal response to angioplasty with 316L stainless steel stenting in the swine iliac artery as compared with simple balloon angioplasty of the contralateral iliac artery. In their study, stenting was associated with increased intimal hyperplasia, but no reduction of the arterial lumen, due to positive remodeling of the elastic lamina.…”