Differential response of delayed healing and persistent inflammation at sites of overlapping sirolimus- or paclitaxel-eluting stents
Differential response of delayed healing and persistent inflammation at sites of overlapping sirolimus- or paclitaxel-eluting stents
复制标题
DOI：
10.1161/circulationaha.104.508937
复制
发表时间：
2005-07-12
期刊：
影响因子：
37.8
通讯作者：
Virmani, R
中科院分区：
文献类型：
--
作者：
Finn, AV;Kolodgie, FD;Virmani, R
背景-虽然有效覆盖的挑战性冠状动脉病变有必要使用重叠药物洗脱支架，支架重叠的组织病理学反应是unknown.Methods和Results -动脉反应重叠Cypher或紫杉醇药物洗脱支架进行了检查，在兔裸金属支架，BxVelocity或Express，作为对照。单髂动脉球囊损伤后，在60只动物中放置2个重叠的3.0 mm直径药物洗脱支架或裸金属支架（平均重叠长度，9.8 ± 3.6 mm）。在第28天和第90天采集支架动脉进行组织学检查。在28天时，与近端和远端非重叠部位相比，重叠节段的愈合延迟。与Cypher相比，Taxus支架中的重叠节段诱导了显著更多的管腔异嗜中性粒细胞/嗜酸性粒细胞和纤维蛋白沉积;然而，后者中的支柱周围巨细胞浸润更常见。重叠裸金属支架与非重叠段相比也显示轻度延迟愈合，但程度与药物洗脱支架不同。尽管28天和90天Cypher支架重叠处的新生内膜厚度相似，但Taxus支架的新生内膜厚度显著增加（P = 0.03）。结论：与裸金属支架相比，药物洗脱支架进一步延迟动脉愈合，并促进重叠部位的炎症。Taxus支架诱导了更大的纤维蛋白沉积、中膜细胞丢失、异嗜中性粒细胞/嗜酸性粒细胞和晚期新生内膜增生。接受重叠药物洗脱支架的患者比接受非重叠支架的患者需要更频繁的随访。
Background - Although effective coverage of challenging coronary lesions has warranted the use of overlapping drug-eluting stents, the histopathological response to stent overlap is unknown.Methods and Results - The arterial reaction to overlapping Cypher or Taxus drug-eluting stents was examined in rabbits with bare metal stents, BxVelocity or Express, serving as controls. Single iliac artery balloon injury was followed by placement of 2 overlapping 3.0-mm-diameter drug-eluting stents or bare metal stents in 60 animals ( mean length of overlap, 9.8 +/- 3.6 mm). Stented arteries were harvested at 28 and 90 days for histology. Overlapped segments exhibited delayed healing compared with proximal and distal nonoverlapping sites at 28 days. Overlapped segments in Taxus stents induced significantly more luminal heterophils/eosinophils and fibrin deposition than Cypher; peristrut giant cell infiltration, however, was more frequent in the latter. Overlapping bare metal stents also showed mild delayed healing compared with nonoverlapped segments, but not to the same extent as drug-eluting stents. Although neointimal thickness within the overlap was similar in 28- and 90-day Cypher stents, there was a significant increase with Taxus (P = 0.03).Conclusions - Compared with bare metal stents, drug-eluting stents further delay arterial healing and promote inflammation at sites of overlap. Taxus stents induced greater fibrin deposition, medial cell loss, heterophils/eosinophils, and late neointimal hyperplasia. Patients receiving overlapping drug-eluting stents need more frequent follow-up than patients with nonoverlapping stents.