Korean Circ J.  2007 Jan;37(1):33-38. 10.4070/kcj.2007.37.1.33.

Re-endothelization and Inflammatory Reaction at Site of Overlapping Drug-Eluting Stents in a Porcine Coronary In-Stent Restenosis Model

• Lim SY
• Jeong MH
• Kim JH
• Lee SR
• Moon JY
• Hong YJ
• Kim JH
• Ahn Y
• Cho JG
• Park JC
• Kim KS
• Joo SJ
• Kang JC

• KMID: 2227091
• DOI: http://doi.org/10.4070/kcj.2007.37.1.33

Abstract

BACKGROUND AND OBJECTIVES: This study was conducted to evaluate the inflammatory reaction at sites of overlapping stents in a porcine in-stent restenosis (ISR) model.
MATERIALS AND METHODS
Twenty bare metal stents (BMS, Group I; n=10), 20 sirolimus-eluting stents (SES, Group II; n=10), 20 paclitaxel-eluting stents (PES, Group III; n=10), 10 PESs and 10 SESs (Group IV; n=10) were deployed and overlapped in the left anterior descending coronary arteries of 40 pigs. Follow-up coronary angiograms and histopathologic analysis were performed at 4 weeks after stenting.
RESULTS
The minimal luminal diameter of the overlapped segment at 4 weeks was smaller in group I than that in the other groups (1.78+/-0.13 mm vs. 2.79+/-0.09 mm vs. 2.90+/-0.04 mm vs. 2.80+/-0.07 mm, respectively, p<0.001). The neointimal area (5.51+/-0.58 mm2 vs. 2.38+/-0.53 mm2 vs. 2.07+/-0.37 mm2 vs. 2.39+/-0.58 mm2, respectively, p<0.001) and the area stenosis (68.74+/-4.02% vs. 27.79+/-4.73% vs. 23.66+/-3.24% vs. 27.63+/-4.07%, respectively, p<0.001) of the overlapped segment were significantly higher in Group I than that in the other groups. The inflammatory score of the overlapped segment was significantly higher in Group III than that in the other groups (1.80+/-0.42 vs. 2.10+/-0.32 vs. 2.90+/-0.31 vs. 2.50+/-0.52, respectively, p<0.001). The endothelization score of the overlapped segment was significantly lower in Group III than that in the other groups (2.80+/-0.42 vs. 2.30+/-0.67 vs. 1.30+/-0.48 vs. 2.10+/-0.74, respectively, p<0.001).
CONCLUSION
Compared with the BMS, the DES inhibits neointimal hyperplasia, but inflammation and poor endothelization are observed at the sites of overlapped stents.

Keyword

Coronary disease; Restenosis; Stents

MeSH Terms

Constriction, Pathologic
Coronary Disease
Coronary Vessels
Drug-Eluting Stents*
Follow-Up Studies
Hyperplasia
Inflammation
Phenobarbital
Stents
Swine
Phenobarbital

Figure

• 

  Fig. 1 Methyl methacrylate staining. A: overlapped bare stent group. B: overlapped sirolimus-eluting stent (SES) group. C: overlapped paclitaxeleluting stent (PES) group. D: overlapped SES and PES group. Overlapped PES group showed exposed stent struts into the lumen and poor endothelization.

• 

  Fig. 2 High power light microscopic findings (×200) of Hematoxyline and Eosin staining. A: overlapped bare stent group. B: overlapped sirolimus-eluting stent (SES) group. C: overlapped paclitaxel-eluting stent (PES) group. D: overlapped SES and PES group. The number of Inflammatory cells in overlapped PES group was higher than that of other groups.

• 

  Fig. 3 Histopathologic assessment of overlapped segment of porcine coronary arteries (A) minimal luminal diameter (mm). B: lumen area (mm2). C: neointimal area (mm2). D: area stenosis (%). E: inflammation score. F: endothelization score. Group I: overlapped bare stent group, Group II: overlapped sirolimus-eluting stent (SES) group, Group III: overlapped paclitaxel-eluting stent (PES) group, Group IV: overlapped SES and PES group.

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