Abstract
Background: Titanium is commonly used in blood-exposed medical devices because it has superior blood compatibility. Mycophenolic acid inhibits the proliferation of vascular smooth muscle cells. This study examined the effect of a non-polymer TiO2 thin film–coated stent with mycophenolic acid in a porcine coronary overstretch restenosis model. Methods: Thirty coronary arteries in 15 pigs were randomized into three groups in which the coronary arteries were treated with a TiO2 film–coated stent with mycophenolic acid (NTM, n = 10), everolimus-eluting stent with biodegradable polymer (EES, n = 10), or TiO2 film–coated stent (NT, n = 10). A histopathologic analysis was performed 28 days after the stenting. Results: There were no significant intergroup differences in injury score, internal elastic lamina area, or inflammation score. Percent area stenosis was significantly smaller in the NTM and EES groups than in the NT group (36.1 ± 13.63% vs. 31.6 ± 7.74% vs. 45.5 ± 18.96%, respectively, p = 0.0003). Fibrin score was greater in the EES group than in the NTM and NT groups [2.0 (range, 2.0–2.0) vs. 1.0 (range, 1.0–1.75) vs. 1.0 (range, 1.0–1.0), respectively, p < 0.0001]. The in-stent occlusion rate measured by micro-computed tomography demonstrated similar percent area stenosis rates on histology analysis (36.1 ± 15.10% in NTM vs. 31.6 ± 8.89% in EES vs. 45.5 ± 17.26% in NT, p < 0.05). Conclusion: The NTM more effectively reduced neointima proliferation than the NT. Moreover, the inhibitory effect of NTM on smooth muscle cell proliferation was not inferior to that of the polymer-based EES with lower fibrin deposition in this porcine coronary restenosis model.
Highlights
The treatment of acute myocardial infarction (AMI) has rapidly evolved over the past few decades from thrombolysis therapy to coronary stents including bare metal stents (BMS), metal-based drug-eluting stents (DES), and bioresorbable vascular scaffolds® (BVS)
First-generation DES reduced in-stent restenosis (ISR) rates compared to former treatments, delayed re-endothelialization and late stent thrombosis (LST) have emerged as major concerns (Stettler et al, 2007; Wenaweser et al, 2008)
Stent thrombosis was significantly reduced compared to firstgeneration DES (Leon et al, 2010)
Summary
The treatment of acute myocardial infarction (AMI) has rapidly evolved over the past few decades from thrombolysis therapy to coronary stents including bare metal stents (BMS), metal-based drug-eluting stents (DES), and bioresorbable vascular scaffolds® (BVS). First-generation DES reduced in-stent restenosis (ISR) rates compared to former treatments, delayed re-endothelialization and late stent thrombosis (LST) have emerged as major concerns (Stettler et al, 2007; Wenaweser et al, 2008). The permanent polymer coatings of BMS were related with poor re-endothelialization and LST (Murphy et al, 1992; Nebeker et al, 2006; Stone et al, 2007). To overcome this limitation, biocompatible and/or biodegradable polymers were applied in second- and thirdgeneration DES (Meredith et al, 2005). This study examined the effect of a non-polymer TiO2 thin film–coated stent with mycophenolic acid in a porcine coronary overstretch restenosis model
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