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Heart. 2007 Dec;93(12):1609-15. Epub 2007 Jul 16.

Coronary artery overexpansion increases neointimal hyperplasia after stent placement in a porcine model.

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Division of Cardiovascular Diseases, Scripps Clinic, SW206, 10666 North Torrey Pines Road, La Jolla, CA 92037, USA.



To determine if an aggressive approach to coronary revascularisation with oversized balloons is counterproductive, we studied the effect of increasing balloon-to-artery (B:A) ratio on neointimal hyperplasia following primary stent placement using a non-atherosclerotic porcine coronary overstretch model.


60 vessels in 33 Yorkshire swine were randomly assigned to one of five B:A ratios between 1.0:1 and 1.4:1. Intravascular ultrasound (IVUS) imaging was performed before bare-metal stent placement to accurately determine vessel size, after stent placement, and at 28 days.


The mean prestent vessel diameter was 3.05 (0.31) (SD) mm. In-stent neointimal volume, in-stent volume stenosis and cross-sectional area stenosis at the stent minimum lumen diameter increased significantly with increasing achieved B:A ratio (multilevel regression test for slope, p<0.001, p = 0.002 and p<0.001, respectively) and were independent of vessel size. Even minor vessel overstretch at an achieved B:A ratio of 1.1:1 resulted in significant neointimal hyperplasia. Larger B:A ratios were also associated with more neointima beyond the stent edges (p = 0.008). For vessels from the same animal, neointimal response at a given B:A ratio was dependent upon the animal treated.


In a porcine model of IVUS-guided coronary primary stent placement, vessel overexpansion is counterproductive. Neointimal hyperplasia at 28 days is strongly associated with increasing B:A ratio. In addition, vessels do not respond independently of each other when multiple stents are placed within the same animal using a range of B:A ratios.

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