可降解雷帕霉素洗脱支架对猪冠状动脉支架置入术后内膜增生的影响  

Effect of Biodegradable Rapamycin-Eluting Stent on Neointimal Proliferation in Porcine Coronary Artery Model

作　　者：郑金刚[1] 高润霖[1] 程树军[2] 王春宁[1] 钱杰[1] 阮英茆[1] 王清峙[3] 袁晋青[3] 孟亮[4] 乔树宾[1] 陈纪林[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院冠心病诊治中心,北京市100037 [2]上海华东理工大学高分子研究室 [3]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院病理科,北京市100037 [4]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院实验动物科,北京市100037

出　　处：《中国循环杂志》2004年第3期190-193,共4页Chinese Circulation Journal

摘　　要：目的 :考察可降解雷帕霉素洗脱支架对冠状动脉支架置入术后近期及远期内膜增生影响。方法 :所有 2 4只小型猪随机分为 1个月及 3个月两部分 ,每部分再随机分为A、B、C 3小组 ,每小组 4只 ,分别于左冠状动脉前降支及右冠状动脉置入裸支架、聚合物洗脱支架及雷帕霉素洗脱支架 ,于术后 1个月或 3个月后动物处死前行冠状动脉造影 ,处死后用组织形态学方法观察内膜增生情况。结果 :47枚支架均成功地置入 2 4头小型猪的冠状动脉 ,术后均存活。术后即刻冠状动脉造影显示均通畅 ,处死前冠状动脉造影显示 ,1个月部分A组及B组各相关动脉均通畅 ,而C组有 1支冠状动脉完全闭塞 ;3个月部分各动脉均通畅。形态学分析 ,与裸支架比较 ,1个月及 3个月结果均显示聚乳酸洗脱支架对内膜增生无刺激作用 ;1个月结果显示药物支架可使管腔直径增加 18 0 % (P <0 0 5 ) ,管腔面积增加 2 2 6% (P <0 0 5 ) ,面积狭窄百分比减少 43 % (P <0 0 5 ) ,内膜面积减少 3 5 1% (P >0 0 5 ) ;3个月部分结果显示 ,药物洗脱支架对内膜增生的抑制作用消失 ,甚至有刺激内膜增生的趋势。结论 :以聚乳酸为载体的可降解雷帕霉素洗脱支架在小型猪冠状动脉模型虽能抑制 1个月血管内膜增生 ,但远期效果欠佳 。Objective:To study the short-term and long-term effect of biodegradable rapamycin-coated stent on the neointimal proliferation. Methods:Fourty eight stents(16 bare stents,16 polylactide-co-glycolide(PLGA)-coated stents and 16 rapamycin-eluting stents)were randomly delivered into left anterior descending arteries and right coronary arteries of 24 minipigs.One or 3 months later after procedure coronary angiogram was performed immediately before the pigs were sacrificced. Results:Forty eight stents were successfully delivered into the coronaries of 24 pigs.All the animals survived. The coronary angiogram showed that total occlusion developed in one vessel with rapamycin eluting stent in one-month group,and all the other arteries were patent.Histomorphometric results showed that,compared with bare stent group,the polymer coated stent group had similar neointimal proliferation revealed by both one-month result and three-month result.One-month result showed that,compared with bare stent group,the rapamycin-eluting stent group had larger lumen diameter (2 734±419 μm vs 2 316±344 μm,p<0.05) and larger lumen area(5.76±0.93 vs 4.70±0.64 mm 2,p<0.05).On the other hand,the area stenosis(22.6±11.4%vs 39.7±12.8%,p<0.05) was significantly smaller in the rapamycin-eluting stent group and the neointimal area trended to decrease(1.57±0.64 mm 2 vs 2.42±0.90 mm 2,p>0.05)in high dose group.Three-month result showed that the inhibitory effect of rapamycin-eluting stents on neointimal proliferation disappeared,and the rapamycin-eluting stent trended to stimulate neointimal proliferation in a porcine model. Conclusion:Though rapamycin-eluting stents can inhibit neointimal proliferation in a short time,its effect could not maintain for a long time.The clinical significance of this result needs to be observed.

关 键 词：支架 药物洗脱 再狭窄 雷帕霉素 冠心病 

分 类 号：R541.4[医药卫生—心血管疾病]