Abstract
Purpose: To evaluate the efficacy of antithrombotic agents in the prevention of stenosis of polytetrafluororethylene (PTFE)-covered stents in the venous system.
Methods: Spiral Z stents covered with PTFE (PTFE-covered stents) were placed in the inferior vena cava (IVC) of 34 dogs. Nineteen dogs, used as a control group, were sacrificed at 2, 4, and 12 weeks. Fifteen dogs, previously given antithrombotic agents [cilostazol (n=5), warfarin potassium (n=5), cilostazol plus warfarin potassium (n=5)] were sacrificed at 4 weeks, and then examined angiographically and histopathologically. The effect of the antithrombotic agents was compared between groups.
Results: The patency rate of the antithrombotic agent group was 93% (14/15), which was higher than the control group rate of 63% (12/19). The mean stenosis rate of the patent stent at both ends and at the midportion was lower at 4 weeks in the antithrombotic agent group than in the control group. In particular, the mean stenosis rate in the cilostazol plus warfarin potassium group was significantly lower than the control group (Tukey’s test, p < 0.05). The mean neointimal thickness of the patent stent at both ends and at the midportion was thinner at 4 weeks in the antithrombotic agent group than in the control group. In particular, the thickness of the neointima in the cilostazol plus warfarin potassium group was significantly decreased when compared with the control group (Tukey’s test p < 0.05). At 4 weeks, endothelialization in the antithrombotic agent group tended to be almost identical to that in the control group.
Conclusion: The present study suggests that administration of an antithrombotic agent is an effective way of preventing the stenosis induced by a neointimal thickening of PTFE-covered stents in the venous system.
Similar content being viewed by others
References
Rösch J, Uchida BT, Hall LD, Antonovic R, Petersen BD, Ivancev K, Barton RE, Keller FS (1992) Gianturco-Rösch expandable Z-stents in the treatment of superior vena cava syndrome. Cardiovasc Intervent Radiol 15:319–327
Sawada S, Fujiwara Y, Koyama T, Kobayashi M, Tanigawa N, Iwamiya T, Katsube Y, Nakamura H, Furui S (1992) Application of expandable metallic stents to the venous system. Acta Radiol 33:156–159
Kishi K, Sonomura T, Mitsuzane K, Nishida N, Yang R, Sato M, Yamada R, Shirai S (1993) Self-expandable metallic stent therapy for superior vena cava syndrome: Clinical observations. Radiology 189:531–535
Makutani S, Maeda M, Yoshioka T, Kichikawa K, Matsuo N, Ohishi H, Uchida H (1995) Usefulness of metallic stent for venous obstruction. Jpn J Phlebol 6:221–228
Chin DH, Peterson BD, Timmermans H, Rösch J (1996) Stent-graft in the management of superior vena cava syndrome. Cardiovasc Intervent Radiol 19:302–304
Yoshioka T, Kitano S, Makutani S, Maeda M, Kichikawa K, Kubota Y, Ohishi H, Uchida H (1995) Management of portal vein thrombosis of hepatocellular carcinoma with covered metallic stent. IVR 10(3):327–330
Maeda M, Timmermans H, Uchida BT, Uchida H, Keller FS, Rösch J (1992) In vitro comparison of the spiral Z-stent and the Gianturco Z-stent. J Vasc Interv Radiol 3:565–569
Takahashi S, Nakai T, Miyabo S (1992) Effect of cilostazol and PGE1 on proliferation of rat arterial smooth muscle cells in culture. J Jpn Coll Angiol 32:651–655
Kubota Y, Kichikawa K, Uchida H, Maeda M, Nishimine K, Makutani S, Sakaguchi S, Yoshioka T, Ohishi H, Kimura Y, Yoshikawa T (1995) Pharmacologic treatment of intimal hyperplasia after metallic stent placement in the peripheral arteries. Invest Radiol 30:532–535
Ishimaru S, Fujiwara Y, Domeki K, Horiguchi T, Furukawa K, Takahashi M (1977) Defibrinogenation therapy in venous reconstructive surgery using ePTFE graft: Its possibilities and limitations. J Jpn Coll Angiol 17(5):515–520
Kimura T (1977) The process of pseudointimal formation in the expanded polytetrafluoroethylene graft inserted into the venous system. J Jpn Coll Angiol 17(3):273–281
Yasutake T (1977) Expanded polytetrafluoroethylene (Gore Tex) graft for caval replacement in the dog: Evaluation of patency and neointima. J Jpn Coll Angiol 17(6):667–676
Ohkuma T (1984) Replacement of the portal vein with e-PTFE vascular graft: Experimental study on the process of endothelialization. J Jpn Surg Soc 85:1558–1569
Ghidoni JJ, Liotta D, Hall CW, Adams JG, Lechter A, Barrionueva M, O’Neal RM, DeBakey ME (1968) Healing of pseudointimas in velour-lined impermeable arterial prosthesis. Am J Pathol 53:375–389
Clowes AW, Kirkman TR, Reidy MA (1986) Mechanisms of arterial graft healing: Rapid transmural capillary ingrowth provides a source of intimal endothelium and smooth muscle in porous PTFE prostheses. Am J Pathol 123:220–230
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Makutani, S., Kichikawa, K., Uchida, H. et al. Effect of antithrombotic agents on the patency of PTFE-Covered stents in the inferior vena cava: An experimental study. Cardiovasc Intervent Radiol 22, 232–238 (1999). https://doi.org/10.1007/s002709900373
Issue Date:
DOI: https://doi.org/10.1007/s002709900373