Abstract
BackgroundAlthough drug-eluting stents have dramatically reduced the rates of restenosis and target lesion revascularization, they are associated with stent thrombosis (ST), a catastrophic event likely due to delayed endothelialization and chronic inflammation caused by the polymer and the metal scaffolds. To increase the safety and efficacy of stents, polymer-free dual drug-eluting stents (DDES) have been developed.MethodsA total 160 stents (Bare-metal stents (BMS), polymer-free probucol stents (PrES), sirolimus-eluting stents (SES) and DDES) were randomly implanted in the coronary arteries of 80 pigs. 14, 28, 90 and 191 days after implantation, QCA and OCT evaluations were performed in 20 pigs respectively, and the arteries were harvested for scanning electron microscope (SEM), histomorphology, histopathology analyses and for the relative expression of CD31, CD34 and CD133 on mRNA and protein levels.ResultsAt the 14-day time point, there were significant differences in the strut rate coverage (p = 0.011), with greater coverage in the PrES than in the SES group (53.2%vs. 20.3%, p = 0.002). As well, there were no significant differences in the expression of CD31, CD34 and CD133 between groups in mRNA and protein level.ConclusionsDDES were as safe as BMS and SES, but they did not further improve the endothelialization of the stented coronary arteries in the porcine model.
Highlights
Drug-eluting stents have dramatically reduced the rates of restenosis and target lesion revascularization, they are associated with stent thrombosis (ST), a catastrophic event likely due to delayed endothelialization and chronic inflammation caused by the polymer and the metal scaffolds
Noninvasive percutaneous coronary intervention (PCI) with stenting has become the standard of care, but delayed endothelialization and chronic inflammation caused by the polymer and the metal scaffolds lead to the development of stent restenosis (SR) and stent thrombosis (ST), the most important clinical problems following PCI
Autopsy studies have shown that the best morphometric predictor of late ST was the ratio of uncovered struts relative to the total stent struts, which is a marker of stent endothelialization [5]
Summary
Drug-eluting stents have dramatically reduced the rates of restenosis and target lesion revascularization, they are associated with stent thrombosis (ST), a catastrophic event likely due to delayed endothelialization and chronic inflammation caused by the polymer and the metal scaffolds. Probucol is a potent antioxidant and lipid-lowering drug, it is effective in reducing the risk of restenosis and the incidence of major adverse cardiac events after PCI [6]. Several studies, both in animals and humans, have shown some improvement in the rate of endothelialization of the stented arteries by probucol [7,8,9]
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