Method for Percutaneously Introducing, and Removing, Anatomical Stenosis of Predetermined Severity In Vivo: The "Stenotic Stent"
Method for Percutaneously Introducing, and Removing, Anatomical Stenosis of Predetermined Severity In Vivo: The "Stenotic Stent"
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DOI：
10.1007/s12265-013-9476-x
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发表时间：
2013-08-01
影响因子：
3.4
通讯作者：
Davies, Justin
中科院分区：
文献类型：
--
作者：
Foin, Nicolas;Sen, Sayan;Davies, Justin
目前的动脉损伤活体模型往往在病变解剖和血流动力学意义上导致不可预测的结果。这项研究的目的是使用一种新的体内可调狭窄模型来评估冠状动脉狭窄的影响，该模型能够模拟先进的人类冠状动脉病变。我们研制了一系列具有中心限制的球囊可膨胀覆膜冠状动脉支架，模拟不同的中度到重度狭窄，并将它们经皮植入8头健康杂交长白猪的冠状动脉内。在狭窄支架置入后，沿动脉获得光学相干断层扫描(OCT)回撤和部分血流储备(FFR)，以准确评估解剖和功能影响。平均直径为54.1±-5.9%，平均狭窄面积为78.4±-5.8%，平均FFR为0.83(SD=0.13)。OCT评价的FFR与MLA的相关性较低(r=0.02，p=0.94)，随着面积狭窄率的增加而改善(r=-0.55，p=0.12)，或者OCT不仅考虑MLA，还考虑病变的长度(r=-0.78，p=0.01)。这项研究提供了一种在体内经皮引入和移除预定严重程度的解剖狭窄的方法和概念证明。这种活体模型可用于建立和评估局灶性狭窄对FFR等生理参数的影响。
Current in vivo models of arterial lesions often lead to unpredictable results in terms of lesion anatomy and hemodynamical significance. This study aimed to evaluate the impact of coronary stenosis using a novel in vivo adjustable stenosis model capable of mimicking advanced human coronary lesions. We developed a series of balloon expandable covered coronary stents with a central restriction, mimicking different intermediate to severe stenosis, and implanted them percutaneously in coronary arteries of eight healthy hybrid Landrace pigs. Optical coherence tomography (OCT) pullbacks and fractional flow reserve (FFR) were acquired along the artery after implantation of the stenotic stents for precise evaluation of anatomy and functional impact. Diameter and area stenosis after deployment of the stenosis implant were, on average, respectively, 54.1 +/- 5.9 and 78.4 +/- 5.8 % and average FFR value was 0.83 (SD 0.13). There was a low correlation between FFR and MLA evaluated by OCT (r = 0.02, p = 0.94), improved with percentage area stenosis (r = -0.55, p = 0.12), or OCT volumetric evaluation of the stenosis taking into account not only the MLA but also the length of the lesion (r = -0.78, p = 0.01). This study presents a method and proof of concept for percutaneously introducing, and removing, anatomical stenosis of predetermined severity in vivo. Such in vivo model may be used to create and evaluate the impact of focal stenoses on physiological parameters such as FFR.