Polyethylene terephthalate and polyurethane coatings for endovascular stents: preliminary results in canine experimental arteriovenous fistulas.

Abstract

To evaluate polyethylene terephthalate and polyurethane as coatings of vascular endoprostheses in the treatment of experimental arteriovenous fistulas (AVFs). Nineteen bilateral carotid artery-to-external jugular vein AVFs were created in 10 adult dogs. Fourteen polyethylene terephthalate-coated and five polyurethane-coated self-expandable nitinol stents were placed with a transfemoral approach. Angiography was performed immediately after placement, after 1 and 3 weeks, and at months 3, 6, 9, and 12. All grafts were examined histopathologically. The AVF was successfully occluded with all but one of the polyethylene terephthalate-coated stents. Graft patency was seen with 12 polyethylene terephthalate-coated stents, while acute vessel occlusion was evident with two polyethylene terephthalate-coated stents following percutaneous transluminal angioplasty immediately after implantation. In the group with polyurethane-coated stents, three graft dislocations and two delayed vessel occlusions were observed. In both groups, histologic examination disclosed a mild foreign body reaction with a few macro-phages. No inflammatory reactions were seen. An unorganized fibrin layer was found adjacent to the polyurethane coating. Polyethylene terephthalate-coated nitinol stents showed good biocompatibility and a high rate of occlusion of experimental AVFs. The mechanical properties of the polyethylene terephthalate coating were similar to those of the nitinol stents, which facilitated handling. Polyurethane-coated stents showed frequent dislocation.