Author + information
- Received March 6, 2017
- Revision received June 16, 2017
- Accepted June 29, 2017
- Published online December 4, 2017.
- Hiroyoshi Mori, MDa,
- Qi Cheng, MDa,
- Christoph Lutter, MDa,
- Samantha Smith, MSa,
- Liang Guo, PhDa,
- Matthew Kutyna, MSa,
- Sho Torii, MDa,
- Emanuel Harari, MDa,
- Eduardo Acampado, DVMa,
- Michael Joner, MDa,
- Frank D. Kolodgie, PhDa,
- Renu Virmani, MDa and
- Aloke V. Finn, MDa,b,∗ ()
- ↵∗Address for correspondence:
Dr. Aloke V. Finn, CVPath Institute Inc., 19 Firstfield Road, Gaithersburg, Maryland 20878.
Objectives This study sought to investigate endothelial coverage and barrier protein expression following stent implantation.
Background Biodegradable polymer drug-eluting stents (BP-DES) have been purported to have biological advantages in vessel healing versus durable polymer DES (DP-DES), although clinical trial data suggest equipoise.
Methods Biodegradable polymer-sirolimus-eluting stents (BP-SES), durable polymer-everolimus-eluting stents (DP-EES), and bare-metal stents (BMS) were compared. In the rabbit model (28, 45, and 120 days), stented arteries underwent light microscopic analysis and immunostaining for the presence of vascular endothelium (VE)-cadherin, an endothelial barrier protein, and were subjected to confocal microscopy and scanning electron microscopy. A cell culture study in stented silicone tubes was performed to assess cell proliferation.
Results Light microscopic assessments were similar between BP-SES and DP-EES. BMS showed nearly complete expression of VE-cadherin at 28 days, whereas both DES showed significantly less with results favoring BP-SES versus DP-EES (39% coverage in BP-SES, 22% in DP-EES, 95% in BMS). Endothelial cell morphologic patterns differed according to stent type with BMS showing a spindle-like shape, DP-EES a cobblestone pattern, and BP-SES a shape in between. VE-cadherin-negative areas showed greater surface monocytes regardless of type of stent. Cell proliferation was suppressed in both DES with numerically less suppression in BP-SES versus DP-EES.
Conclusions This is the first study to examine VE-cadherin expression after DES. All DES demonstrated deficient barrier expression relative to BMS with results favoring BP-SES versus DP-EES. These findings may have important implications for the development of neoatherosclerosis in different stent types.
CVPath Institute has received research grants from Abbott Vascular, Atrium Medical, Boston Scientific, Biosensors International, Cordis–Johnson&Johnson, Medtronic CardioVascular, OrbusNeich Medical, and Terumo Corporation. Dr. Mori has received honorarium from Abbott Vascular Japan, Goodman, and Terumo Corporation. Dr. Torii has received honorarium from Abbott Vascular Japan, Terumo Corporation, and SUNRISE Lab. Dr. Joner is a consultant for Biotronik, Coramaze, AUM Medical, Orbus Neich; and has received honorarium from Biotronik, Boston Scientific, AstraZeneca, and Orbus Neich. Dr. Virmani has speaking engagements with Merck; receives honoraria from Abbott Vascular, Boston Scientific, Lutonix, Medtronic, and Terumo Corporation; and is a consultant for 480 Biomedical, Abbott Vascular, Medtronic, and W.L. Gore. Dr. Finn has sponsored research agreements with Boston Scientific and Medtronic CardioVascular; and is an advisory board member to Medtronic CardioVascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 6, 2017.
- Revision received June 16, 2017.
- Accepted June 29, 2017.
- 2017 American College of Cardiology Foundation