Key result
In a mini-swine model of stent implantation, neointima formation was invariant to sex, but significant differences between females and males were observed in injury, inflammation, adventitial fibrosis, and fibrin deposition.
Why the study?
Are there sex-related differences in the vascular responses to stent implantation in a mini-swine model?
Are there sex-related differences in the vascular responses to stent implantation in a mini-swine model?
In a mini-swine model of stent implantation, significant sex differences exist in vascular injury, inflammation, and fibrin deposition, highlighting the importance of considering sex in preclinical vascular device evaluation.
Answers are grounded in this paper and cite their sources.
Should not change stent practices by sex; leaves open whether swine differences in injury and inflammation apply to human PCI.
Sex-related differences have been noted in cardiovascular anatomy, pathophysiology, and treatment responses, yet we continued to drive evaluation of vascular device development in animal models without consideration of animal sex. We aimed to understand sex-related differences in the vascular responses to stent implantation by analyzing the pooled data of endovascular interventions in 164 Yucatan mini-swine (87 female, 77 male). Bare metal stents (BMS) or drug-eluting stents (DES) were implanted in 212 coronary arteries (63 single BMS implantation, 68 single DES implantation, 33 overlapped BMS implantation, and 48 overlapped DES implantation). Histomorphological parameters were evaluated from vascular specimens at 3-365 days after stent implantation and evaluated values were compared between female and male groups. While neointima formation at all times after implantation was invariant to sex, statistically significant differences between female and male groups were observed in injury, inflammation, adventitial fibrosis, and neointimal fibrin deposition. These differences were observed independently, i.e., for different procedure types and at different follow-up timings. Only subtle temporal sex-related differences were observed in extent and timing of resolution of inflammation and fibrin clearance. These subtle sex-related differences may be increasingly important as interventional devices meld novel materials that erode and innovations in drug delivery. Erodible materials may act differently if inflammation has a different temporal sequence with sex, and drug distribution after balloon or stent delivery might be different if the fibrin clearance speaks to different modes of pharmacokinetics in male and female swine.
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Kunio et al. (2018) studied Coronary artery stent implantation (n=164). Female sex vs. Male sex was evaluated on Neointima area and luminal occlusion. In a mini-swine model of stent implantation, neointima formation was invariant to sex, but significant differences between females and males were observed in injury, inflammation, adventitial fibrosis, and fibrin deposition.
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