Tsukada Jitsuro, Mela P, Jinzaki M, Tsukada H, Schmitz-Rode T, Vogt F
Department of Diagnostic Radiology, Nihon University School of Medicine, 30-1, Oyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
Department of Diagnostic Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan.
Stem Cell Rev Rep. 2022 Jan;18(1):179-197. doi: 10.1007/s12015-021-10238-3. Epub 2021 Aug 17.
Endovascular treatment is prevalent as a primary treatment for coronary and peripheral arterial diseases. Although the introduction of drug-eluting stents (DES) dramatically reduced the risk of in-stent restenosis, stent thrombosis persists as an issue. Notwithstanding improvements in newer generation DES, they are yet to address the urgent clinical need to abolish the late stent complications that result from in-stent restenosis and are associated with late thrombus formation. These often lead to acute coronary syndromes with high mortality in coronary artery disease and acute limb ischemia with a high risk of limb amputation in peripheral arterial disease. Recently, a significant amount of research has focused on alternative solutions to improve stent biocompatibility by using tissue engineering. There are two types of tissue engineering endothelialisation methods: in vitro and in vivo. To date, commercially available in vivo endothelialised stents have failed to demonstrate antithrombotic or anti-stenosis efficacy in clinical trials. In contrast, the in vitro endothelialisation methods exhibit the advantage of monitoring cell type and growth prior to implantation, enabling better quality control. The present review discusses tissue-engineered candidate stents constructed by distinct in vitro endothelialisation approaches, with a particular focus on fabrication processes, including cell source selection, stent material composition, stent surface modifications, efficacy and safety evidence from in vitro and in vivo studies, and future directions.
血管内治疗作为冠状动脉和外周动脉疾病的主要治疗方法已很普遍。尽管药物洗脱支架（DES）的引入显著降低了支架内再狭窄的风险，但支架血栓形成仍然是一个问题。尽管新一代DES有所改进，但它们仍未满足消除由支架内再狭窄导致并与晚期血栓形成相关的晚期支架并发症这一迫切的临床需求。这些并发症在冠状动脉疾病中常导致具有高死亡率的急性冠状动脉综合征，在外周动脉疾病中则导致具有高截肢风险的急性肢体缺血。最近，大量研究集中在通过组织工程改善支架生物相容性的替代解决方案上。组织工程内皮化方法有两种类型：体外和体内。迄今为止，市售的体内内皮化支架在临床试验中未能证明其抗血栓或抗狭窄功效。相比之下，体外内皮化方法具有在植入前监测细胞类型和生长的优势，从而能够实现更好的质量控制。本综述讨论了通过不同的体外内皮化方法构建的组织工程候选支架，特别关注制造过程，包括细胞来源选择、支架材料组成、支架表面改性、体外和体内研究的功效和安全性证据以及未来方向。
