In-stent restenosis: Contributions of inflammatory responses and arterial injury to neointimal hyperplasia
In-stent restenosis: Contributions of inflammatory responses and arterial injury to neointimal hyperplasia
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DOI：
10.1016/s0735-1097(97)00450-6
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发表时间：
1998-01-01
影响因子：
24
通讯作者：
Leon, MB
中科院分区：
文献类型：
--
作者：
Kornowski, R;Hong, MK;Leon, MB
目标.我们在猪冠状动脉过度牵张再狭窄模型中研究了炎症和动脉损伤对新生内膜形成的相对作用。以往的研究表明支架引起的新生内膜增生与损伤成正比。尽管炎症被认为是血管成形术后再狭窄的主要原因，但关于炎症与随后的新生内膜形成之间关系的数据很少。21只猪行球囊损伤后，在左前降支植入超大型、管状、开槽支架（支架/动脉比1.2：1），1个月后对损伤程度（损伤评分0 ~ 3分）和炎症（炎症评分0 ~ 3分）进行形态计量学分析，并与新生内膜形成进行相关性分析。在21只猪中有20只观察到炎症反应，并且发现动脉损伤程度与炎症反应程度之间存在显著正相关炎症反应程度与新生内膜厚度呈显著正相关（r = 0.80，P < 0.01）支架内新生内膜面积（r = 0.53，p = 0.01）和狭窄面积百分比（r = 0.66，p < 0.01）。重要的是，只有在没有损伤的情况下才有炎症区域，反之亦然，这也与新生内膜增生有关。这些数据表明，炎症反应在冠状动脉支架术后新生内膜形成中起着与动脉损伤同等重要的作用，抗炎方法可能对减少支架内再狭窄有价值。(C)1998年，美国心脏病学会。
Objectives. We examined the relative contributions of inflammation and arterial injury to neointimal formation in a porcine coronary overstretch restenosis model.Background. Previous studies established that stents cause neointimal proliferation proportional to injury, Although inflammation has been postulated to be a major contributor to restenosis after angioplasty, there is a paucity of data on the relation between inflammation and subsequent neointimal formation.Methods. Twenty-one pigs underwent balloon injury followed by implantation of oversized, tubular, slotted stents (stent/artery ratio 1.2:1) in the left anterior descending coronary artery, Morphometric analysis of the extent of injury (graded as injury score 0 to 3) and inflammation (graded as inflammation score 0 to 3) 1 month later was assessed and correlated with neointimal formation.Results. An inflammatory reaction was observed in 20 of 21 pigs, and significant positive correlations were found between the degree of arterial injury and the extent of the inflammatory reaction (r = 0.80, p < 0.01) and between the extent of inflammatory reaction and the neointimal thickness (r = 0.75, p < 0.01), neointimal area (r = 0.53, p = 0.01) and percent area stenosis (r = 0.66, p < 0.01) within the stents, Importantly, there were areas with inflammation only in the absence of injury, and vice versa, that were also associated with neointimal hyperplasia.Conclusions. These data suggest that the inflammatory reaction plays an equally important role as arterial injury in neointimal formation after coronary stenting, and that, anti-inflammatory approaches may be of value to reduce in-stent restenosis. (C) 1998 by the American College of Cardiology.