Towards Neoatherosclerosis: A Porcine Model for Enhanced Device Testing.

The porcine in-stent stenosis model has been essential for developing drug-coated devices but does not replicate the hyperlipidemic, pro-atherogenic conditions driving neoatherosclerosis. We aimed to establish a practical porcine model for testing endovascular therapies targeting neoatherosclerosis. Juvenile pigs were fed a high-fat, nicotine-supplemented diet (HFDN). After two weeks, bare-metal stents were implanted in coronary and peripheral arteries; controls received a standard diet. Four weeks later, stented, and non-stented artery segments were analyzed. HFDN feeding induced elevated serum LDL and cotinine. At follow-up, in-stent late lumen loss was significantly greater in peripheral arteries (A. iliaca: 2.3 ± 0.6 vs. 1.1 ± 0.5 mm; A. femoralis: 3.4 ± 1.2 vs. 2.0 ± 0.4 mm), but not coronary arteries. HFDN-fed pigs showed distinct signs of early neoatherosclerosis, including peri-strut foam cell accumulations and atheroma formation. Elemental imaging and chemical analysis confirmed increased calcium phosphate deposition in arteries of HFDN-fed pigs. This straightforward protocol enables testing of devices aimed at preventing or treating neoatherosclerosis.