Investigation of the Endothelial Response of Super Elastic Braided Stent: An Experimental Evaluation

Yıl 2020, Cilt: 4 Sayı: 3, 236 - 241, 29.10.2020

Oğuz Karahan , Naci Öcal , Tuğçe Sümer , Erhan Hafız , Emced Khalil

https://doi.org/10.30565/medalanya.745576

Öz

Aim: This study aimed to experimentally investigate the vascular biocompatibility of the new super elastic braided stents and ultrasonographically follow up the mid-term outcomes on the blood flow of stent-implanted vessels.

Method: After designation of the study steps, stents were implanted into the iliac arteries of two ewes. The preoperative and postoperative blood flow and local findings were noted. The ewes were inspected periodically for abnormal body changes, and the stent-implanted vessels were checked with Doppler ultrasonography. The subjects were sacrificed at six months, and the iliac arteries were examined histopathologically.

Results: During follow up an occlusive pattern was not observed in the stent-implanted vessels. The histopathological analysis revealed that both two stent area had no significant neointimal hyperplasia, despite sufficient re-endothelisation at the stent surface. Occlusive or stenotic patterns were not detected in both macroscopic and microscopic findings.

Conclusion: According to the mid-term findings, our results show that the new super elastic bare stents have good vascular biocompatibility with high patency rates.

Anahtar Kelimeler

Super elastic bare stent, vascular biocompatibility, neointimal hyperplasia, experimental model

Süper Elastik Örgülü Stentin Endotel Yanıtının İncelenmesi: Deneysel Bir Değerlendirme

Öz

Amaç: Bu çalışmada yeni süper elastik çıplak stentlerin vasküler biyoyararlanımının deneysel olarak araştırılması ve stent implante edilen damarların kan akışındaki orta dönem sonuçlarının ultrasonografik olarak izlenmesi amaçlandı.

Yöntem: Çalışma adımlarının belirlenmesinden sonra stentler iki koyun ilyak arterlerine implante edildi. Ameliyat öncesi ve sonrası kan akışı ve lokal bulgular kaydedildi. Denekler anormal vücut değişiklikleri açısından periyodik olarak takip edildi ve stent implante edilen damarlar Doppler Ultrasonografi ile kontrol edildi. Denekler 6. ayda sakrifiye edildi ve iliak arterler histopatolojik olarak incelendi.

Bulgular: Takip sırasında stent implante edilmiş damarlarda herhangi bir oklüzyon paterni gözlenmedi. Histopatolojik analiz, stent yüzeyinde yeterli yeniden endotelizasyona rağmen, her iki stent bölgesinin de belirgin neointimal hiperplazi olmadığını ortaya koydu. Makroskopik veya mikroskopik bulgularda oklüzif veya stenotik patern saptanmadı.

Sonuç: Sonuçlarımız, yeni süper elastik çıplak stentlerin, orta dönem bulgularına göre yüksek açıklık oranları ile iyi vasküler biyoyararlılığa sahip olduğunu göstermiştir.

Anahtar Kelimeler

Super elastic çıplak stent, vasküler biyouyumluluk, neointimal hiperplazi, deneysel model

Kaynakça

• 1. Firnhaber JM, Powell CS. Lower Extremity Peripheral Artery Disease: Diagnosis and Treatment. Am Fam Physician. 2019;99(6):362-369. PMID: 30874413
• 2. Sontheimer DL. Peripheral vascular disease: diagnosis and treatment. Am Fam Physician. 2006 ;73(11):1971-6. PMID: 16770929
• 3. Pancioli AM. Combination pharmacotherapy for achievement and maintenance of vascular patency. Stroke. 2009;40(3 Suppl):S99-102. DOI: 10.1161/STROKEAHA.108.529800. PMID: 19064809
• 4. Vorwerk D, Gu¨nther RW, Schu¨rmann K, Wendt G. Aortic and iliac stenoses: follow- up results of placement after insufficient balloon angioplasty. Radiology 1996; 198:45–48. DOI: 10.1148/radiology.198.1.8539403, PMID: 8539403
• 5. Schürmann K, Vorwerk D, Uppenkamp R, Klosterhalfen B, Bu¨cker A, Gu¨nther RW. Iliac arteries: plain and heparin-coated Dacron-covered stent-grafts compared with noncovered metal stents—an experimental study. Radiology 1997; 203:55–63. DOI: 10.1148/radiology.203.1.9122416, PMID: 9122416
• 6. Schürmann K, Lahann J, Niggemann P, Klosterhalfen B, Meyer J, Kulisch A, et al., Biologic response to polymer-coated stents: in vitro analysis and results in an iliac artery sheep model. Radiology. 2004;230(1):151-62. DOI: 10.1148/radiol.2301021071, PMID: 14645877
• 7. Lineberger CK, Robertson KM. Vascular stenting. Curr Opin Anaesthesiol. 2002;15(1):37-44. DOI: 10.1097/00001503-200202000-00006, PMID: 17019182
• 8. Tomberli B, Mattesini A, Baldereschi GI, Di Mario C. A Brief History of Coronary Artery Stents. Rev Esp Cardiol (Engl Ed). 2018;71(5):312-319. DOI: 10.1016/j.rec.2017.11.022, PMID: 29361499
• 9. Alt E, Haehnel I, Beilharz C, Prietzel K, Preter D, Stemberger A, et al., Inhibition of neointima formation after experimental coronary artery stenting: a new biodegradable stent coating releasing hirudin and the prostacyclin analogue iloprost. Circulation. 2000;101(12):1453-8. DOI: 10.1161/01.cir.101.12.1453, PMID: 10736292
• 10. Ishikawa O, Tanaka M, Konno K, Hasebe T, Horikawa A, Iijima A, et al., Swine model of in-stent stenosis in the iliac artery evaluating the serial time course. Exp Anim. 2018 Nov 1;67(4):501-508. doi: 10.1538/expanim.18-0027. DOI: 10.1538/expanim.18-0027, PMID: 30068792
• 11. Dolmatch B, Dong YH, Heeter Z. Evaluation of three polytetrafluoroethylene stent-grafts in a model of neointimal hyperplasia. J Vasc Interv Radiol. 2007;18(4):527-34. DOI: 10.1016/j.jvir.2007.02.011, PMID: 17446544
• 12. Edwards JM, Alloosh MA, Long XL, Dick GM, Lloyd PG, Mokelke EA, et al., Adenosine A1 receptors in neointimal hyperplasia and in-stent stenosis in Ossabaw miniature swine. Coron Artery Dis. 2008;19(1):27-31. DOI: 10.1097/MCA.0b013e3282f262b4, PMID: 18281812
• 13. Schürmann K, Vorwerk D, Bücker A, Grosskortenhaus S, Günther RW. Single and tandem stents in sheep iliac arteries: is there a difference in patency? Cardiovasc Intervent Radiol. 1998;21(5):411-8. DOI: 10.1007/s002709900289, PMID: 9853148
• 14. Sun S, Beitler JJ, Ohki T, Calderon TM, Schechner R, Yaparpalvi R, et al., Inhibitory effect of brachytherapy on intimal hyperplasia in arteriovenous fistula. J Surg Res. 2003;115(2):200-8. DOI: 10.1016/s0022-4804(03)00253-1, PMID: 14697284
• 15. Zain MA, Siddiqui WJ. Neointimal Hyperplasia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2018. http://www.ncbi.nlm.nih.gov/books/NBK499893/. Accessed Jan 2020. PMID: 29763068
• 16. Collins MJ, Li X, Lv W, Yang C, Protack CD, Muto A, et al., Therapeutic strategies to combat neointimal hyperplasia in vascular grafts. Expert Rev Cardiovasc Ther. 2012;10(5):635-47. DOI: 10.1586/erc.12.33, PMID: 22651839
• 17. Ocke Reis PE, Behrendt CA. Covered Versus Bare-metal Stents for Iliac Occlusive Disease. J Vasc Endovasc Therapy 2019; 4(3):15
• 18. Cejna M, Virmani R, Jones R, Bergmeister H, Losert U, Xu Z, et al. Biocompatibility and performance of the Wallstent and several covered stents in a sheep iliac artery model. J Vasc Interv Radiol. 2001;12(3):351-8. DOI: 10.1016/s1051-0443(07)61916-2, PMID: 11287514
• 19. Geraghty PJ, Mewissen MW, Jaff MR, Ansel GM; VIBRANT Investigators. Three-year results of the VIBRANT trial of VIABAHN endoprosthesis versus bare nitinol stentimplantation for complex superficial femoral artery occlusive disease. J Vasc Surg. 2013 ;58(2):386-95.e4. DOI: 10.1016/j.jvs.2013.01.050,PMID: 23676191
• 20. Piazza M, Squizzato F, Dall'Antonia A, Lepidi S, Menegolo M, Grego F, et al. Editor's Choice - Outcomes of Self Expanding PTFE Covered Stent Versus Bare Metal Stent for Chronic Iliac Artery Occlusion in Matched Cohorts Using Propensity Score Modelling. Eur J Vasc Endovasc Surg. 2017;54(2):177-185. DOI: 10.1016/j.ejvs.2017.03.019, PMID: 28487112