■目前,商业支架是冠状动脉穿孔(CAP)的主要治疗方法,但与药物洗脱支架(DES)相比,没有令人满意的晚期结局。本研究旨在报道一种新的覆膜支架治疗猪CAP,它是用DES和由聚-L-乳酸(PLLA)聚合物制成的可生物降解膜制造的。
■实验猪在右冠状动脉(RCA)的近端中段经历了非顺应性球囊破裂的CAP,覆膜支架在破裂段展开。同时,冠状动脉造影(CAG),光学相干断层扫描(OCT),采用组织学光学显微镜和扫描电镜对覆膜支架的性能进行表征。
■本研究使用了七只猪。两头猪在手术后14天和28天安乐死,分别。剩下的5人一直活着,直到六个月牺牲。六个月时的CAG显示所有猪的RCA支架段完全闭塞。在两头猪中进行了阻塞病变的介入性血运重建。再通闭塞病变后,OCT检查可视化弥漫性非均质纤维斑块,以及有组织的血栓形成,脂质沉积和闭塞段的一些新动脉粥样硬化。14天连续组织病理学和电子显微镜检查,28天和6个月发现逐渐闭塞的血管腔伴有弥漫性异质性纤维增生,平滑肌增殖,炎症反应和局部新动脉粥样硬化,此外,还鉴定了PLLA聚合物膜的降解性。
■带有生物可降解膜的新型覆膜支架可以密封紧急的冠状动脉破裂并防止实验性猪死亡,但是在中期(六个月)随访中,所有支架闭塞,这可能归因于弥漫性异质性纤维增生,平滑肌增殖,炎症反应和局部新动脉粥样硬化与PLLA膜降解。
UNASSIGNED: Currently, commercially covered stents are the main treatment for coronary artery perforation (CAP), but without satisfied late-term outcomes when compared to drug-eluting stents (DES). This study seeks to report a new covered stent to treat porcine CAP, which is manufactured with DES and a biodegradable membrane fabricated by poly-L-lactic acid (PLLA) polymer.
UNASSIGNED: Experimental swines experienced CAP in proximal-middle of right coronary artery (RCA) by non-compliant balloon burst, and covered stent was deployed in breach segment. Meanwhile, coronary angiography (CAG), optical coherence tomography (OCT), histological light microscopy and scan electron microscopy were performed to characterize the performance of covered stent.
UNASSIGNED: Seven swines were used for this study. Two swines were euthanasia at 14 days and 28 days after procedure, respectively. The remaining 5 kept alive until sacrifice at six months. CAG at six months showed total occlusion at the stented segment of RCA in all swines. The interventional revascularization of occlusion lesion was instituted in two swines. After recanalizing occlusion lesion, OCT examination visualized diffuse heterogeneous fibrous plaques, as well as organized thrombosis, lipid deposits and several neoatherosclerosis in the occluded segment. Serial histopathologic and electron microscopies at 14 days, 28 days and six months revealed gradual occlusive vessel lumen with diffuse heterogeneous fibroplasia, smooth muscle proliferation, inflammation response and local neoatherosclerosis, moreover with identification of PLLA polymer membrane degradability.
UNASSIGNED: The new covered stent with biodegradable membrane could seal urgent coronary breach and prevent experimental swines death, but with all stent occlusion in mid-term (six months) follow-up, which might be attributed to diffuse heterogeneous fibroplasia, smooth muscle proliferation, inflammation response and local neoatherosclerosis with the degradation of PLLA membrane.