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J Thorac Cardiovasc Surg 1996;112:79-84
© 1996 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

EXTERNAL STENTING REDUCES EARLY MEDIAL AND NEOINTIMAL THICKENING IN A PIG MODEL OF ARTERIOVENOUS BYPASS GRAFTING

Supported by grants from the British Heart Foundation and The Garfield Weston Trust.

Received for publication May 24, 1995 Accepted for publication August 28, 1995. Address for reprints: G. D. Angelini, FRCS, British Heart Foundation, Professor of Cardiac Surgery, Department of Cardiac Surgery, University of Bristol, Bristol BS2 8 HW, United Kingdom.

Abstract

The long-term clinical success of coronary artery bypass grafting with autologous saphenous vein is limited by progressive medial and neointimal thickening in the graft and superimposed atherosclerosis. We sought to reduce wall thickening by applying an external stent to experimental grafts in pigs. The diameter of the stent was designed to allow unrestricted initial expansion of the vein in response to arterial pressure and the stent material was highly porous so as to minimize advential disruption. Four weeks after graft implantation, stented grafts had a larger lumen (11.2 ± 6.2 [standard deviation] mm²versus 7.6 ± 3.4 mm², p < 0.05, n = 9) and an almost fourfold thinner media (0.14 ± 0.08 versus 0.49 ± 0.22, p < 0.001) and neointima (0.10 ± 0.07 versus 0.35 ± 0.24, p < 0.001) than paired unstented grafts in the same animals. Cell proliferation was also greatly reduced by stenting in the neointimal and medial layers. The stenting procedure devised here is readily applicable to clinical coronary bypass grafts. (J THORAC CARDIOVASC SURG 1996;112:79-84)

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