Pathophysiologic Consequences of Early Coarctation Stenting in a Longitudinal Porcine Model

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2026-09-01 Epub Date: 2026-06-21 DOI:10.1002/ccd.70692

Leah M. Gober, Michael A. Stellon, Matt A. Culver, Amy Frenkel, Dana Irrer, Colleen M. Witzenburg, Alejandro Roldán-Alzate, Luke Lamers

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引用次数: 0

Abstract

Background

Novel stent technologies offer early intravascular treatment options for coarctation (COA). Mid-to-long-term cardiovascular responses to early COA stent interventions are undefined.

Aims

We studied a porcine model of COA, with and without early stent implantation with serial dilation to adult aortic diameters, aiming to define longitudinal cardiovascular changes.

Methods

In total, 18 swine were studied: 6 shams, 6 COA controls (CC), and 6 COA stents (CS). Surgical COA was induced at 2 weeks (4.5 kg) followed by stent implant at 6 weeks, with serial dilations at 12 and 20 weeks (80 kg). All animals were terminally studied at 20 weeks.

Results

Successful stent implantation with serial dilation matching somatic growth occurred in all CS animals with predictable stent performance and elimination of COA. No in-stent stenosis observed. Final stent dimensions equaled the proximal descending aorta (DAo) of shams (16.8 ± 1.5 vs. 17.5 ± 0.8, p = 0.3); however, DAo narrowing (13.3 ± 1.1 mm) just distal to the stent without gradient was created because of stent shortening, and this DAo segment demonstrated decreased vessel wall collagen content. Four of 6 animals developed peri-stent aneurysms treated with covered stents. CS prevented post stenotic dilation and collateralization and resulted in near normalization of catheter-derived hemodynamics. Cardiac MRI documented similar ventricular function, cardiac index, and myocardial tissue characterization between groups. Early COA stenting was associated with increased systemic arterial elastin content.

Conclusion

In this swine COA model, early stent implants effectively dilated to adult aortic dimensions, prevented blood pressure gradients, collateralization, and adverse myocardial remodeling. Early stenting with serial dilations altered systemic arterial elastin content, and additional stents may be necessary to enlarge the adjacent DAo. Aneurysm formation frequently occurred.

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纵向猪模型早期缩窄支架植入术的病理生理后果。

背景：新型支架技术为血管缩窄（COA）提供了早期血管内治疗选择。早期COA支架介入治疗的中长期心血管反应尚不明确。目的：我们研究了猪COA模型，有和没有早期支架植入，连续扩张到成人主动脉直径，旨在确定纵向心血管变化。方法：共对18头猪进行研究：假体6头，COA对照（CC） 6头，COA支架（CS） 6头。在第2周（4.5 kg）诱导手术COA，在第6周植入支架，在第12周和第20周（80 kg）连续扩张。所有动物在20周时进行终期研究。结果：所有CS动物都成功植入了与躯体生长相匹配的连续扩张支架，支架性能可预测，COA消除。未见支架内狭窄。最终支架尺寸等于假体近端降主动脉（DAo）（16.8±1.5 vs. 17.5±0.8,p = 0.3）；然而，由于支架缩短，仅在支架远端形成DAo狭窄（13.3±1.1 mm），无梯度，并且该DAo段显示血管壁胶原含量降低。6只动物中有4只在有盖支架治疗后出现支架周围动脉瘤。CS防止狭窄后扩张和侧支，导致导管源性血流动力学接近正常化。心脏MRI记录了两组间相似的心室功能、心脏指数和心肌组织特征。早期COA支架置入与全身动脉弹性蛋白含量增加有关。结论：在猪COA模型中，早期支架植入有效地扩张到成人主动脉尺寸，防止血压梯度、侧支和不良心肌重构。早期连续扩张的支架置入改变了全身动脉弹性蛋白含量，可能需要额外的支架来扩大邻近的DAo。动脉瘤形成是常见的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.