三氧化二砷控释洗脱支架早期和非早期药物释放对犬冠状动脉支架术后再狭窄的影响  

Effect of early and non-early controlled-release of arsenic-trioxide eluting stents on restenosis inhibition in a canine model

作　　者：赵军礼[1] 孙宝贵[1] 温沁竹[1] 张建军[1] 金炜[1] 薛吉祥[1] 庄文燕[1] 

机构地区：[1]上海交通大学附属第一人民医院心内科,200080

出　　处：《中华心血管病杂志》2007年第6期571-574,共4页Chinese Journal of Cardiology

基　　金：上海交通大学附属第一人民医院科学研究基金(2003)

摘　　要：目的比较三氧化二砷(As_2O_3)控释洗脱支架早期和非早期药物释放防治犬冠状动脉支架术后再狭窄的安全性及疗效。方法将裸支架、聚甲基丙烯酸丁酯/纳米二氧化硅单涂层支架、聚甲基丙烯酸丁酯/纳米二氧化硅-聚乳酸/乙醇酸双涂层支架、As_2O_3(200μg/支架)单涂层及双涂层控释洗脱支架随机置入30只犬冠状动脉回旋支或前降支相应节段,每只动物置入同类支架,分为裸支架组、单涂层组、双涂层组、单涂层 As_2O_3支架组和双涂层 As_2O_3支架组。术后4周处死,取支架血管段组织,观察和分析组织学变化。结果各组平均损伤积分相似。光镜可见新生内膜组织形成,未见内膜下出血和中膜、外膜坏死,无附壁血栓及炎性细胞浸润;扫描电镜显示各组内皮完整,未见血栓形成及白细胞黏附。组织形态学分析结果显示:单涂层 As_2O_3支架组与单涂层组和裸支架组、双涂层 As_2O_3支架组与双涂层组和裸支架组比较,平均新生内膜厚度、新生内膜面积、管腔面积狭窄率明显减少(P<0.01),管腔面积显著增大(P<0.01);单涂层 As_2O_3支架组与双涂层 As_2O_3支架组各指标比较,差异有统计学意义(P<0.05);单、双涂层组与裸支架组比较差异无统计学意义。结论As_2O_3控释洗脱支架安全可行,非早期较早期药物释放防治再狭窄作用更显著。Objective To observe the safety and efficacy of early or non-early controlled-release arsenic-trioxide （As2O3 ）-eluting stents on reducing in-stent neointimal hyperplasia. Methods Bare stents, stents coated with polybutyl methacrylate/Nano silica （ containing 200 μg of As2O3 per stent or not ）, stents coated with polybutyl methacrylate/Nano silica inside （ containing 200 μg of As2O3 per stent or not ） and poly-lactide-co-glycolide （PLGA） outside were deployed with mild oversizing in left anterior descending （LAD） and circumflex coronary arteries （ LCX ） of 30 canines （ n = 6, 12 stents for each group ）. Results The mean injury scores were similar in all groups at 4 weeks post stents implantation while the mean neoinimal thickness, neointimal area and degree of stenosis were significantly reduced and the lumen area significantly increased in canines receiving single coating stents containing As2O3 compared with single or double coating stents and bare stents groups （ all P 〈0. 01 ）. These effects were further enhanced in canines implanted with double coating stents containing As2O3 （ all P 〈 0. 01 vs. single coating stents containing As2O3 ）. No intraintimal hemorrhage, medial and adventitial necrosis, aneurysm, thrombosis, inflammatory cells infiltration were observed in all stenting groups. Conclusions Controlled-release As2O3-eluting stents resulted in a significant inhibition of neointimal hyperplasia in the canine coronary arteries 4 weeks after stents implantation and the effects is more significant with controlled-release of As2O3 at non-early stage than that at early stage.

关 键 词：支架 三氧化二砷 再狭窄 犬 

分 类 号：R543[医药卫生—心血管疾病]