Thibodeaux L C, James K V, Lohr J M, Welling R E, Roberts W H
John J. Cranley Vascular Laboratory, Good Samaritan Hospital, Cincinnati, Ohio 45220, USA.
Am J Surg. 1996 Aug;172(2):151-4. doi: 10.1016/S0002-9610(96)00139-0.
Percutaneous balloon angioplasty with intravascular metallic stent placement has rapidly gained popularity for the treatment of arterial occlusive disease. Although the incidence of vascular prosthetic infection is well described, the risk of infection following metallic stent placement is unknown. The purpose of this study was to determine if intravascular metallic stents could become infected following systemic bacterial challenge.
Balloon expandable metallic stents were implanted in the iliac arteries of 10 swine following balloon catheter angioplasty. A second angioplasty, without stent placement, was also performed in the contralateral iliac artery. A bacterial challenge with Staphylococcus aureus was then infused into the aorta immediately after stent placement. Group 1 (n = 5) was killed at 72 hours, and group 2 (n = 5) at 3 weeks. A third group (n = 5) underwent stent placement without bacterial challenge and was killed at 3 weeks. At the time of death, the stents were cultured, and both iliac arteries were submitted for pathologic examination. Arterial patency and evidence of systemic infection were also assessed.
In the animals sacrificed at 72 hours (group 1), 80% had stent cultures with significant growth of S aureus; while at 3 weeks (group 2), 60% of cultures were positive. Of the stents placed without bacterial challenge (group 3), none had a positive culture at 3 weeks. In group 2, 40% of the stented arteries remained patent, while 100% of group 3 remained patent until sacrifice at 3 weeks. All of the stented arteries which were patent at 3 weeks were culture negative, while all those which were thrombosed were culture positive for S aureus. When compared to angioplasty alone, the presence of a stent was strongly associated with pathologic evidence of inflammation [93% versus 7%]. The quality of inflammation in the stented groups also differed. Ninety percent of the stented arteries in groups 1 and 2 had acute inflammation, compared to only 20% in group 3. The remainder of the stented arteries in group 3 had chronic inflammation or were normal.
In the swine model, intravascular metallic stents have the potential to become infected. This is associated with acute inflammation of the arterial wall and vessel thrombosis. Further studies evaluating the incidence of stent infections in humans are needed.
经皮气囊血管成形术联合血管内金属支架置入术在治疗动脉闭塞性疾病方面迅速受到欢迎。虽然血管假体感染的发生率已有详细描述，但金属支架置入后感染的风险尚不清楚。本研究的目的是确定全身细菌攻击后血管内金属支架是否会被感染。
在10头猪的髂动脉中，经气囊导管血管成形术后植入球囊扩张金属支架。对侧髂动脉也进行了第二次血管成形术，但未置入支架。在支架置入后立即将金黄色葡萄球菌注入主动脉进行细菌攻击。第1组（n = 5）在72小时处死，第2组（n = 5）在3周处死。第3组（n = 5）在未进行细菌攻击的情况下置入支架，并在3周时处死。在处死时，对支架进行培养，并将双侧髂动脉送去进行病理检查。还评估了动脉通畅情况和全身感染的证据。
在72小时处死的动物（第1组）中，80%的支架培养有金黄色葡萄球菌显著生长；而在3周时（第2组），60%的培养物呈阳性。在未进行细菌攻击的情况下置入的支架（第3组）中，3周时无一例培养物呈阳性。在第2组中，40%的置入支架的动脉保持通畅，而第3组100%的动脉在3周处死前保持通畅。3周时保持通畅的所有置入支架的动脉培养均为阴性，而所有血栓形成的动脉培养均为金黄色葡萄球菌阳性。与单纯血管成形术相比，支架的存在与炎症的病理证据密切相关[93%对7%]。置入支架组的炎症性质也有所不同。第1组和第2组中90%的置入支架的动脉有急性炎症，而第3组仅为20%。第3组中其余置入支架的动脉有慢性炎症或正常。
在猪模型中，血管内金属支架有被感染的可能性。这与动脉壁的急性炎症和血管血栓形成有关。需要进一步研究评估人类支架感染的发生率。
