Differences in vessel healing following delivery of everolimus or paclitaxel: a comparative experimental study using identical stent and biodegradable polymer platforms

作者：Buszman Piotr P; Milewski Krzysztof; Pajak Jacek; Jelonek Michal; Orlik Bartlomiej; Krauze Agata; Gwiazdowska Nowotka Beata; Wojakowski Wojciech; Tellez Armando; Granada Juan F; Buszman Pawel E

来源：Eurointervention, 2014, 10(6): 724-731.

DOI：10.4244/EIJV1016A125

• biodegradable polymer
• everolimus-eluting stent
• paclitaxel-eluting stent
• porcine coronary model

Aims: We aimed to compare the vascular effects exclusive to antiproliferative agents by using identical stent and biodegradable polymeric matrices eluting everolimus (BP-EES) (Carlo; Balton) and paclitaxel (BP-PES) (Luc-Chopin2; Balton) in the porcine model of coronary injury. %26lt;br%26gt;Methods and results: A total of 37 stents were implanted with 110% overstretch in the coronary arteries of 14 domestic pigs: 13 BP-PES, 16 BP-EES and eight bare metal stents (BMS) (Chopin2; Balton). Coronary angiography was performed after 28 and 90 days, the animals were sacrificed and the stented segments harvested for histopathological evaluation. At 28 days, BP-PES most effectively limited angiographic late loss (LL PES: 0.15 +/- 0.1 vs. EES: 0.40 +/- 0.3 vs. BMS: 0.5 +/- 0.2 mm; p=0.04) and neointimal thickness (NT) in histology (PES: 0.12 [0.1-0.2] vs. EES: 0.38 [0.3-0.4] vs. BMS: 0.35 [0.3-0.4] mm; p%26lt;0.01). The BP-PES had lower endothelialisation (EES: 100% vs. PES: 40 +/- 4% vs. BMS: 97.5 +/- 5%; p%26lt;0.01) and slightly higher inflammation scores (EES: 1 vs. PES: 2.1 +/- 0.3 vs. BMS: 1; p%26lt;0.01). At three months, LL remained unchanged in the EES and BMS groups in contrast to an increase in the PES group (EES: 0.38 +/- 0.3 vs. PES: 0.52 +/- 0.4 vs. BMS: 0.51 +/- 0.3 mm; p=0.69). NT stabilised at 90 days in the EES group in comparison to a fourfold increase in the PES group and a 30% increase in the BMS group (EES: 0.35 [0.3-0.5] vs. PES: 0.53 [0.5-0.8] vs. BMS: 0.46 [0.4-0.5] mm: p=0.07). Stent endothelialisation and inflammation were comparable at 90 days in all groups. %26lt;br%26gt;Conclusions: Temporal differences in vascular response were seen by the delivery of different antiproliferative agents. In contrast to everolimus, paclitaxel seems to induce a slightly higher degree of inflammation in the short term, potentially leading to further neointimal hyperplasia in the long term.

• 出版日期2014-10