Okada Takayuki, Minato Naoki, Kanemoto Shin-Ya, Zempo Nobuya, Saiga Kazuho, Namikawa Ken, Kanno Shohei, Ueno Hiroo
Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
Department of Stem Cell Pathology, Kansai Medical University, Osaka, Japan.
Gen Thorac Cardiovasc Surg. 2019 Aug;67(8):677-683. doi: 10.1007/s11748-019-01083-w. Epub 2019 Feb 21.
Coronary onlay grafting, with or without endarterectomy, has been widely used for the treatment of diffuse lesions. Recent studies have demonstrated excellent long-term patency and favorable remodeling of onlay anastomosis; however, the underlying mechanisms remain unknown. Here, we describe the mechanism of intimal regeneration based on postmortem pathological evaluation of a patient who had undergone onlay grafting with coronary endarterectomy.
The onlay anastomosis was analyzed using a combination of immunohistological stainings, namely, H&E, vimentin, α-SMA, factor VIII, and Ki-67, to identify the source and mechanism of intimal regeneration after onlay grafting with endarterectomy.
Our results suggest that the regenerated endothelium derives from the smooth muscle cells of the endarterectomized media of the coronary artery and that it circumferentially covers the internal lumen of the arterial graft.
Intimal regeneration, derived from the smooth muscle cells of the endarterectomized coronary artery that proliferate toward the graft lumen, may be a key mechanism that underlies the observed favorable remodeling after onlay grafting during coronary endarterectomy.
冠状动脉覆盖移植术，无论是否行内膜切除术，已广泛用于治疗弥漫性病变。近期研究已证实覆盖吻合术具有出色的长期通畅率及良好的重塑效果；然而，其潜在机制仍不明。在此，我们基于对一名接受冠状动脉内膜切除覆盖移植术患者的尸检病理评估，描述内膜再生的机制。
采用免疫组织化学染色组合，即苏木精-伊红染色（H&E）、波形蛋白、α-平滑肌肌动蛋白（α-SMA）、因子VIII及Ki-67，分析覆盖吻合术，以确定冠状动脉内膜切除覆盖移植术后内膜再生的来源及机制。
我们的结果表明，再生内皮来源于冠状动脉内膜切除的中膜平滑肌细胞，并沿圆周方向覆盖动脉移植物的内腔。
内膜再生源于冠状动脉内膜切除后向移植物管腔增殖的平滑肌细胞，这可能是冠状动脉内膜切除覆盖移植术后观察到良好重塑的关键机制。
