Furukawa Takeshi, Kishiro Masahiko, Fukunaga Hideo, Ohtsuki Masahiro, Takahashi Ken, Akimoto Katsumi, Shimizu Toshiaki, Kawasaki Shiori, Kumasaka Toshio
Department of Pediatrics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
Pediatr Cardiol. 2010 Aug;31(6):773-9. doi: 10.1007/s00246-010-9695-8. Epub 2010 May 4.
The outcome of stent implantation for pulmonary vein stenosis (PVS) in children remains poor. Several reports describe placing drug-eluting stents to treat PVS, but their effectiveness remains unknown. In this study, three bare-metal stents (BMSs) and three sirolimus-eluting stents (SESs) were implanted in 1-month-old pigs. The pigs were killed 8 weeks later to compare in-stent stenosis rates. The extent of neointimal thickness, as measured by injury score, was significantly less in the SES group than in the BMS group (injury score 1: BMS 0.351 + or - 0.033 vs SES 0.226 + or - 0.031 mm; P < 0.01; injury score 2: BMS 1.232 + or - 0.244 vs SES 0.609 + or - 0.208 mm; P < 0.01). The pathologic findings showed confluence of inflammatory cells around the stent wires in BMS-treated areas and granuloma formation. Granuloma formation was not seen with SES. The degree of in-stent stenosis was significantly reduced in the SES group, suggesting that the use of drug-eluting stents is an effective treatment for PVS. Because of the small sample size and the considerable variation in injury scores and balloon-to-vein ratios, future studies with larger samples are necessary.
儿童肺静脉狭窄（PVS）支架植入的预后仍然很差。有几份报告描述了使用药物洗脱支架治疗PVS，但它们的有效性尚不清楚。在本研究中，将三个裸金属支架（BMS）和三个西罗莫司洗脱支架（SES）植入1月龄仔猪体内。8周后处死仔猪以比较支架内狭窄率。通过损伤评分测量，SES组新生内膜厚度的程度明显小于BMS组（损伤评分1：BMS 0.351±0.033 vs SES 0.226±0.031 mm；P<0.01；损伤评分2：BMS 1.232±0.244 vs SES 0.609±0.208 mm；P<0.01）。病理结果显示，BMS治疗区域的支架丝周围有炎性细胞融合和肉芽肿形成。SES未见肉芽肿形成。SES组支架内狭窄程度明显降低，表明使用药物洗脱支架是治疗PVS的有效方法。由于样本量小以及损伤评分和球囊与静脉比率存在相当大的差异，未来需要进行更大样本量的研究。
