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比较金属和聚合型可吸收生物支架的急性血栓形成:Magmaris 与 Absorb 在猪动静脉分流模型中的对比。

Comparison of Acute Thrombogenicity for Metallic and Polymeric Bioabsorbable Scaffolds: Magmaris Versus Absorb in a Porcine Arteriovenous Shunt Model.

机构信息

From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.).

出版信息

Circ Cardiovasc Interv. 2017 Aug;10(8). doi: 10.1161/CIRCINTERVENTIONS.116.004762.

Abstract

BACKGROUND

A comparison in acute thrombogenicity between the Magmaris sirolimus-eluting bioabsorbable magnesium scaffold and the Absorb bioresorbable vascular scaffold has not been performed. This study assessed acute thrombogenicity of Magmaris compared with Absorb and the Orsiro hybrid drug-eluting stent in a porcine arteriovenous shunt model.

METHODS AND RESULTS

An ex vivo porcine carotid jugular arteriovenous shunt was established and connected to SYLGARD tubing containing the Magmaris, Absorb, and Orsiro scaffolds/stents and allowed to run in the shunt for a maximum of 1 hour. Twelve shunts (2 shunt runs per pig) were run comparing the 3 scaffolds in alternating order. Nested generalized linear mixed models were used to compare variables between scaffold groups while adjusting for variability between shunt runs. Confocal fluorescent microscopy costaining CD61/CD42b demonstrated that both Magmaris (3.0%) and Orsiro (4.6%) had less platelet coverage of the total scaffold compared with Absorb (21.8%). Scanning electron microscopy demonstrated significantly less thrombus deposition to Magmaris as a percentage of the total scaffold compared with Absorb (5.0% versus 16.1%, =0.02). Magmaris had significantly less PM-1-positive neutrophil and CD14-positive monocyte adherence compared with both Orsiro and Absorb. Orsiro had significantly less monocyte deposition compared with Absorb.

CONCLUSIONS

Despite a similar scaffold strut thickness, the Magmaris sirolimus-eluting bioabsorbable magnesium scaffold was significantly less thrombogenic compared with the Absorb bioresorbable vascular scaffold in an ex vivo porcine arteriovenous shunt model. Further studies are needed to determine whether the reduced thrombogenicity of Magmaris will result in reductions in major cardiovascular events.

摘要

背景

尚未比较 Magmaris 西罗莫司洗脱生物可吸收镁支架与 Absorb 生物可吸收血管支架在急性血栓形成方面的差异。本研究通过猪动静脉分流模型评估 Magmaris 与 Absorb 和 Orsiro 杂交药物洗脱支架的急性血栓形成情况。

方法和结果

建立了一个体外猪颈动脉颈静脉动静脉分流模型,并将 Magmaris、Absorb 和 Orsiro 支架/支架连接到 SYLGARD 管中,并在分流器中运行最长 1 小时。为了比较 3 种支架,以每头猪 2 个分流运行的方式进行了 12 次分流(共 24 次)。使用嵌套广义线性混合模型比较支架组之间的变量,同时调整分流运行之间的变异性。CD61/CD42b 共染色的共聚焦荧光显微镜显示,Magmaris(3.0%)和 Orsiro(4.6%)的血小板覆盖总支架的比例均低于 Absorb(21.8%)。扫描电子显微镜显示,与 Absorb 相比,Magmaris 上的血栓沉积量明显较少(占总支架的 5.0% 对 16.1%,=0.02)。Magmaris 上的 PM-1 阳性中性粒细胞和 CD14 阳性单核细胞黏附明显少于 Orsiro 和 Absorb。与 Absorb 相比,Orsiro 的单核细胞沉积明显减少。

结论

尽管支架支柱厚度相似,但 Magmaris 西罗莫司洗脱生物可吸收镁支架在体外猪动静脉分流模型中与 Absorb 生物可吸收血管支架相比,血栓形成明显减少。需要进一步的研究来确定 Magmaris 的低血栓形成是否会导致主要心血管事件的减少。

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