Remodeling and suppression of intimal hyperplasia of vascular grafts with a distal arteriovenous fistula in a rat model

Feng, Qin; Dardik, Herbert; Pangilinan, Audwin; Robinson, Jody S.; Chuy, Jennifer; Wengerter, Kurt R.

doi:10.1067/mva.2001.116804

Cited by 32 publications

(31 citation statements)

References 15 publications

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“…In 1969, Caro et al 11 published their observations that atherosclerosis develops in areas of low wall shear. After they reported that arterial curvature is commonly helical, resulting in swirling flow and elevation of wall shear, 9 many important observations have been made: (1) IH also develops at areas of low wall shear and conversely is less likely at areas of elevated wall shear 10,12,[22][23][24] ; (2) straight stents reduce the natural helical curvature of an artery; and (3) individual stent designs affect the volume of IH that develops, which is not solely dependent on the degree of injury. [25][26][27][28] Swirling flow induced by a helix has high wall shear [9][10][11][12][13][14] and when generated by a helical dialysis graft reduces the IH when compared with a conventional graft.…”

Section: Discussionmentioning

confidence: 99%

Helical Centerline Stent Improves Patency

Zeller

Gaines

Ansel

et al. 2016

Circ: Cardiovascular Interventions

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The self-expanding stent is laser cut from a nitinol tube and has a 3D helical centerline geometry set into the nitinol shape memory (Figure 1). The stent is an advanced design with repeating 2 crown units and specific connectors that allow both flexibility and helical geometry. The end 3 crowns have gradually reducing radial force to improve the transition in profile from artery to stent. It is Background-Reintervention in the femoropopliteal artery is frequent and a major driver of cost-effectiveness. High wall shear generated by swirling blood flow is associated with reduced occurrence of atherosclerosis and restenosis. This trial investigated the clinical and hemodynamic outcomes of the BioMimics 3D self-expanding tubular nitinol stent with helical centerline geometry compared with a straight stent in the femoropopliteal artery. Methods and Results-In a prospective, multicenter, randomized controlled trial, 76 patients with symptomatic peripheral arterial disease were randomized 2:1 to receive a helical or a straight stent. An independent core laboratory adjudicated angiographic and ultrasound parameters. The primary safety end point was freedom from a composite of all death, target limb amputation, and target lesion revascularization at 30 days. The primary effectiveness end point was freedom from clinically driven target lesion revascularization at 6 months. Patency was a secondary end point. Subjects were followed up for 2 years from intervention. The primary safety (1-sided P<0.01) and efficacy (1-sided P<0.001) end points for the helical stent were met. The proportion of patients treated with the helical stent who maintained patency at 12 and 24 months was 80% and 72%, respectively, compared with 71% and 55% for the control group. The difference was significant through 24 months (P=0.05). Freedom from clinically driven target lesion revascularization for the helical compared with straight stent was 91% versus 92% at 12 months and 91% versus 76% at 24 months. Conclusions-Both groups had similar safety outcomes and clinically driven target lesion revascularization to 2 years.However, after placement of a BioMimics 3D helical stent, there was improved patency to 2 years. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT02163863.(Circ Cardiovasc Interv. 2016;9:e002930.

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Section: Discussionmentioning

confidence: 99%

Helical Centerline Stent Improves Patency

Zeller

Gaines

Ansel

et al. 2016

Circ: Cardiovascular Interventions

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“…20e27 Recent experiments suggest that the creation of a fistula may suppress intimal hyperplasia by release of active cellular molecules. 28,29 Others have also shown enhanced flow through flaps at micro and macro levels. 30e34 An intriguing finding is the need for an arteriovenous loop shunt to enable angiogenic capillary budding in experimental bone regeneration in reactors.…”

Section: Discussionmentioning

confidence: 96%

Update on the Role of the Distal Arteriovenous Fistula as an Adjunct for Improving Graft Patency and Limb Salvage Rates after Crural Revascularization

Dardik

2015

Annals of Vascular Surgery

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“…24 In addition, high blood flow inhibits intimal hyperplasia after arterial injury. 25,26 After 4 days, medial SMC proliferation reaches a peak in both rodent and primate models of injury, and SMCs begin to migrate to the intima. PDGF clearly plays a major stimulatory role for SMC migration in both rodents 27 and primates.…”

Section: Mechanisms Of Vascular Hyperplasia and Hypertrophymentioning

confidence: 99%

Induction of vascular atrophy as a novel approach to treating restenosis. A review

Min

Kenagy

Clowes

2008

Journal of Vascular Surgery

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Regardless of the type of arterial reconstruction, luminal narrowing (stenosis or restenosis) develops in approximately one third of the vessels. In the past, the focus of research has been on the mechanisms of stenosis (intimal hyperplasia, pathologic remodeling) and pharmacologic approaches to prevention. An alternative approach is to induce intimal atrophy after luminal narrowing has developed, thus limiting treatment to only those patients that develop a problem. This approach to treat established disease by reducing wall mass through induction of cell death and extracellular matrix removal would be particularly useful for treating stenosis in synthetic bypass grafts or stented vessels, in which intimal hyperplasia is the primary mechanism of stenosis. This approach may be applicable as well to other vascular proliferative disorders, such as pulmonary hypertension and chronic transplant arteriopathy. Proof of principle has been shown in experiments with antibodies to platelet-derived growth factor (PDGF) receptors that cause neointimal regression in baboon polytetrafluoroethylene (PTFE) grafts and with angiotensin-converting enzyme inhibitors that induce medial atrophy in hypertensive arteries. Possible molecular targets could include PDGF receptors, A20, and BMP4. Further studies are needed to determine the utility of such a therapeutic approach to vascular disease.

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Remodeling and suppression of intimal hyperplasia of vascular grafts with a distal arteriovenous fistula in a rat model

Cited by 32 publications

References 15 publications

Helical Centerline Stent Improves Patency

Helical Centerline Stent Improves Patency

Update on the Role of the Distal Arteriovenous Fistula as an Adjunct for Improving Graft Patency and Limb Salvage Rates after Crural Revascularization

Induction of vascular atrophy as a novel approach to treating restenosis. A review

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