Rittersma Saskia Z H, Meuwissen Martijn, van der Loos Chris M, Koch Karel T, de Winter Robbert J, Piek Jan J, van der Wal Allard C
Department of Cardiology, B2-115, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Atherosclerosis. 2006 Jan;184(1):157-62. doi: 10.1016/j.atherosclerosis.2005.03.049. Epub 2005 Jun 9.
The aim of our study was to compare the histopathological features of restenotic tissue after balloon angioplasty and after stent placement. We emphasized on specific types of inflammatory cells to evaluate the type of tissue immune response in both situations.
A total of 32 patients underwent elective directional coronary atherectomy; 16 patients had restenosis after balloon angioplasty, 16 patients had in-stent restenosis (ISR). Atherectomy specimens were stained with antibodies against T cells, eosinophils, smooth muscle cell actin, macrophages and with antibodies against T cell activation markers. Quantitative morphometric analysis was performed using image analysis software.
In-stent restenotic tissue contained more smooth muscle cells (P < 0.001), anti-CD3 positive T cells (P < 0.001) and eosinophils (P = 0.012). Anti-CD40L positive activated T cells were more numerous in ISR lesions (P = 0.003) and were frequently clustered around stent imprints in the tissue. Five ISR specimens contained grossly visible stent fragments amidst the restenotic tissue. In all cases of balloon restenosis, T cells and eosinophils (if present) were concentrated around lipid rich tissue.
Our study indicates involvement of inflammatory responses in both types of restenosis, with significantly more eosinophils encountered in case of in-stent restenosis. In contrast with clustering of inflammatory cells around stent struts after stent placement, the inflammatory cells in balloon restenosis were located in association with lipid rich tissue, suggesting different inflammatory triggers in balloon restenosis and in-stent restenosis.
我们研究的目的是比较球囊血管成形术后和支架置入术后再狭窄组织的组织病理学特征。我们着重于特定类型的炎症细胞，以评估两种情况下的组织免疫反应类型。
总共32例患者接受了选择性冠状动脉定向斑块旋切术；16例患者在球囊血管成形术后发生再狭窄，16例患者发生支架内再狭窄（ISR）。对斑块旋切术标本用抗T细胞、嗜酸性粒细胞、平滑肌肌动蛋白、巨噬细胞的抗体以及抗T细胞活化标志物的抗体进行染色。使用图像分析软件进行定量形态计量分析。
支架内再狭窄组织含有更多的平滑肌细胞（P < 0.001）、抗CD3阳性T细胞（P < 0.001）和嗜酸性粒细胞（P = 0.012）。抗CD40L阳性活化T细胞在ISR病变中更多见（P = 0.003），并且经常聚集在组织中的支架印记周围。5例ISR标本在再狭窄组织中含有肉眼可见的支架碎片。在所有球囊再狭窄病例中，T细胞和嗜酸性粒细胞（如果存在）集中在富含脂质的组织周围。
我们的研究表明炎症反应参与了两种类型的再狭窄，支架内再狭窄时嗜酸性粒细胞明显更多。与支架置入后炎症细胞围绕支架支柱聚集不同，球囊再狭窄中的炎症细胞与富含脂质的组织相关，提示球囊再狭窄和支架内再狭窄存在不同的炎症触发因素。
