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We hypothesize that concomitance of drug and SF leads to greater neointimal response.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>Controlled release of therapeutic agents, such as sirolimus and its analogs, or paclitaxel from has reduced tissue based DES failure modes compared to BMS. ISR is dramatically reduced and yet the implications of mechanical device failure is magnified.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Bilateral Xience Everolimus\u2010eluting stents (EES) were implanted in 20 New Zealand White rabbits on normal (<jats:italic>n<\/jats:italic> =\u20097) or high fat (HF)\/high cholesterol (HC) (<jats:italic>n<\/jats:italic> =\u200913) diets. Implanted stents were intact or mechanically fractured. Everolimus concentration was as packaged or pre\u2010eluted. After 21\u2009days, stented vessels were explanted, resin embedded, MicroCT scanned, and analyzed histomorphometrically.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fractured EES were associated with significant (<jats:italic>P<\/jats:italic> &lt;\u20090.05) increases in arterial stenosis and neointimal formation and lower lumen\u2010to\u2010artery area ratios compared to intact EES. Hyperlipidemic animals receiving pre\u2010eluted EES revealed no significant difference between intact and fracture groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>SF increases intimal hyperplasia, post EES implant, and worse with more advanced disease. Pre\u2010eluted groups, reflective of BMS, did not show significant differences, suggesting a synergistic effect of everolimus and mechanical injury, potentially explaining the lack of SF reports for BMS. Here, we report that ISR has a higher incidence with SF in EES, the clinical implication is that patients with SF after DES implantation merit careful follow\u2010up.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.27726","type":"journal-article","created":{"date-parts":[[2018,9,23]],"date-time":"2018-09-23T12:29:55Z","timestamp":1537705795000},"page":"278-285","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Fracture in drug\u2010eluting stents increases focal intimal hyperplasia in the atherosclerosed rabbit iliac artery"],"prefix":"10.1002","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4236-2280","authenticated-orcid":false,"given":"Claire","family":"Conway","sequence":"first","affiliation":[{"name":"Institute for Medical Engineering and Science Massachusetts Institute of Technology  Cambridge Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerard J.","family":"Desany","sequence":"additional","affiliation":[{"name":"Winchester Engineering and Analytical Center US Food and Drug Administration  Winchester Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynn R.","family":"Bailey","sequence":"additional","affiliation":[{"name":"Concord Biomedical Sciences and Emerging Technologies  Lexington Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John H.","family":"Keating","sequence":"additional","affiliation":[{"name":"Concord Biomedical Sciences and Emerging Technologies  Lexington Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian L.","family":"Baker","sequence":"additional","affiliation":[{"name":"Winchester Engineering and Analytical Center US Food and Drug Administration  Winchester Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elazer R.","family":"Edelman","sequence":"additional","affiliation":[{"name":"Institute for Medical Engineering and Science Massachusetts Institute of Technology  Cambridge Massachusetts"},{"name":"Cardiovascular Division, Brigham and Women's Hospital Harvard Medical School  Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,9,23]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000485"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2007.06.024"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa012843"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.10709"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2004.034538"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2004.12.087"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2010.06.010"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.05.075"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-015-1476-3"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.21569"},{"key":"e_1_2_7_12_1","unstructured":"American Veterinary Medical Association: Guidelines for the Euthanasia of Animals:2013Edition. 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