Deutsches Herzzentrum München and Deutsches Zentrum für Herz-Kreislaufforschung e.V., Munich, Germany.
EuroIntervention. 2020 Dec 4;16(11):e922-e929. doi: 10.4244/EIJ-D-19-00747.
Neoatherosclerosis is a frequent finding after implantation of permanent metallic stents. Bioresorbable scaffolds (BRS) are considered to reduce the incidence of neoatherosclerosis owing to their dissolution and consequent vascular restoration. The aim of this study was to evaluate the formation of neoatherosclerosis between magnesium-based BRS and thick-strut metallic drug-eluting stents (DES) in a rabbit model of neoatherosclerosis and in proportion to the effect of high-dose statin medication.
Fully bioresorbable magnesium scaffolds (BRS, n=45) and thick-strut permanent metallic DES of equivalent geometry and design (n=45) were implanted into the iliac arteries of New Zealand White rabbits (n=45) following endothelial balloon injury and exposure to a cholesterol diet. Endothelialisation was assessed in 12 animals after 35 days using scanning electron microscopy (SEM), showing significantly enhanced re-endothelialisation above struts in the BRS (n=13) compared to DES (n=10). Eleven (11) animals were terminated for baseline assessment after 91 days while the remaining 22 animals were randomised to receive high-dose statin treatment (3 mg/kg) or placebo. BRS-treated vessels showed a significant reduction in foam cell infiltration as a sign of early neoatherosclerosis by histology and OCT when compared to thick-strut DES-treated vessels. Statin treatment resulted in significant reduction of foam cell infiltration in BRS and DES by histology.
Our findings suggest reduced neoatherosclerosis formation in magnesium-based BRS relative to thick-strut DES. High-dose statin treatment may be a promising measure to reduce neoatherosclerosis progression, both on its own and in synergy with site-targeted device-based treatment.
在永久性金属支架植入后，新生动脉粥样硬化是一种常见的发现。生物可吸收支架（BRS）被认为可以减少新生动脉粥样硬化的发生率，因为它们的溶解和随后的血管恢复。本研究的目的是在新生动脉粥样硬化兔模型中评估镁基 BRS 与厚壁金属药物洗脱支架（DES）之间新生动脉粥样硬化的形成，并与大剂量他汀类药物治疗的效果成正比。
在新西兰白兔（n=45）的髂动脉内皮球损伤和暴露于胆固醇饮食后，分别植入全生物可吸收镁支架（BRS，n=45）和等效几何形状和设计的厚壁永久性金属 DES（n=45）。在 35 天后，使用扫描电子显微镜（SEM）评估 12 只动物的内皮化情况，结果显示 BRS（n=13）的支架上方明显增强了再内皮化，而 DES（n=10）则没有。11 只动物在 91 天后进行基线评估，其余 22 只动物随机分为高剂量他汀治疗（3mg/kg）或安慰剂组。与厚壁 DES 治疗的血管相比，BRS 治疗的血管在组织学和 OCT 中显示出泡沫细胞浸润减少，这是早期新生动脉粥样硬化的一个标志。他汀类药物治疗在组织学上显著减少了 BRS 和 DES 中的泡沫细胞浸润。
与厚壁 DES 相比，我们的发现表明镁基 BRS 新生动脉粥样硬化形成减少。大剂量他汀类药物治疗可能是一种有前途的措施，可以减少新生动脉粥样硬化的进展，无论是单独使用还是与针对部位的器械治疗协同使用。
