Enhanced extracellular matrix accumulation in restenosis of coronary arteries after stent deployment
Enhanced extracellular matrix accumulation in restenosis of coronary arteries after stent deployment
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DOI：
10.1016/s0735-1097(02)02598-6
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发表时间：
2002-12-18
影响因子：
24
通讯作者：
Wight, TN
中科院分区：
文献类型：
--
作者：
Chung, IM;Gold, HK;Wight, TN
目的：本研究的目的是评估支架部署后不同时期人类冠状动脉支架内再狭窄的细胞和细胞外组成。背景：对于冠状动脉支架内再狭窄来说，内膜生长而不是支架后坐力被认为是重要的。关于支架部署后细胞和细胞外成分随时间变化的数据有限。方法：采用组织化学和免疫细胞化学技术，分析25例患者在放置Palmaz-Schatz支架后0.5至23个月（平均5.7个月），通过定向冠状动脉粥样硬化切除术获得的29例冠状动脉支架内再狭窄组织样本（14例左前降支，10例右冠状动脉，5例左旋支）。结果细胞增殖率低（0% ~ 4%）。含有富含蛋白聚糖的细胞外基质（ECM）的黏液样组织在69%的病例中被发现，并且在支架植入后随着时间的推移而减少。在57%的病例中发现细胞衰竭区域，并且随着支架置入术后时间的延长而增加。在所有样品中存在不同个体分布的葡聚糖、大聚糖、粗聚糖和透明质酸。转化生长因子- β 1阳性染色占80%。α -平滑肌肌动蛋白免疫染色发现大多数细胞为平滑肌细胞，偶有巨噬细胞存在(:！每切片12个细胞)。结论：这些数据表明，增强的ECM积累而不是细胞增殖有助于支架内再狭窄的后期发展。因此，球囊血管成形术治疗支架内再狭窄可能会因以下过程中的ECM变化而失败：1)额外的支架扩张，2)组织挤出支架，或3)组织压缩。(C) 2002年由美国心脏病学会基金会发布。
OBJECTIVES The goal of this study was to evaluate the cellular and extracellular composition of human coronary arterial in-stent restenosis after various periods of time following stent deployment.BACKGROUND Neointimal in-growth rather than stent recoil is thought to be important for coronary arterial in-stent restenosis. There is only limited data on the cellular and extracellular composition changes with time after stent deployment.METHODS We analyzed 29 coronary arterial in-stent restenotic tissue samples (14 left anterior descending coronary artery, 10 right coronary artery, and 5 left circumflex artery) retrieved by using directional coronary atherectomy from 25 patients at 0.5 to 23 (mean, 5.7) months after deployment of Palmaz-Schatz stents employing histochemical and immunocytochemical techniques.RESULTS Cell proliferation was low (0% to 4%). Myxoid tissue containing extracellular matrix (ECM) enriched with proteoglycans was found in 69% of cases and decreased over time after stenting. Cell-depleted areas were found in 57% of cases and increased with time after stenting. Versican, biglycan, perlecan, and hyaluronan were present with varying individual distributions in all samples. Positive transforming growth factor-beta1 staining was found in 80% of cases. Immunostaining with alpha-smooth muscle actin identified the majority of cells as smooth muscle cells with occasional macrophages present (:! 12 cells per section).CONCLUSIONS These data suggest that enhanced ECM accumulation rather than cell proliferation contribute to later stages of in-stent restenosis. Balloon angioplasty of in-stent restenosis may, therefore, fail due to ECM changes during: 1) additional stent expansion, 2) tissue extrusion out of the stent, or 3) tissue compression. (C) 2002 by the American College of Cardiology Foundation.