IMR Press / RCM / Volume 24 / Issue 7 / DOI: 10.31083/j.rcm2407197
Open Access Original Research
Mid-Term Outcomes of Novel Covered Stent with Biodegradable Membrane in Porcine Coronary Artery Perforation
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1 Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Artery Disease, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian, China
2 School of Health, Fujian Medical University, 350005 Fuzhou, Fujian, China
*Correspondence: lianglongchenfj@126.com (Lianglong Chen)
These authors contributed equally.
Rev. Cardiovasc. Med. 2023, 24(7), 197; https://doi.org/10.31083/j.rcm2407197
Submitted: 2 December 2022 | Revised: 27 January 2023 | Accepted: 28 February 2023 | Published: 12 July 2023
(This article belongs to the Special Issue The Pathophysiology of Acute Coronary Syndromes)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Background: Currently, commercially covered stents are the main treatment for coronary artery perforation (CAP), but without satisfied late-term outcomes when compared to drug-eluting stents (DES). This study seeks to report a new covered stent to treat porcine CAP, which is manufactured with DES and a biodegradable membrane fabricated by poly-L-lactic acid (PLLA) polymer. Methods: Experimental swines experienced CAP in proximal-middle of right coronary artery (RCA) by non-compliant balloon burst, and covered stent was deployed in breach segment. Meanwhile, coronary angiography (CAG), optical coherence tomography (OCT), histological light microscopy and scan electron microscopy were performed to characterize the performance of covered stent. Results: Seven swines were used for this study. Two swines were euthanasia at 14 days and 28 days after procedure, respectively. The remaining 5 kept alive until sacrifice at six months. CAG at six months showed total occlusion at the stented segment of RCA in all swines. The interventional revascularization of occlusion lesion was instituted in two swines. After recanalizing occlusion lesion, OCT examination visualized diffuse heterogeneous fibrous plaques, as well as organized thrombosis, lipid deposits and several neoatherosclerosis in the occluded segment. Serial histopathologic and electron microscopies at 14 days, 28 days and six months revealed gradual occlusive vessel lumen with diffuse heterogeneous fibroplasia, smooth muscle proliferation, inflammation response and local neoatherosclerosis, moreover with identification of PLLA polymer membrane degradability. Conclusions: The new covered stent with biodegradable membrane could seal urgent coronary breach and prevent experimental swines death, but with all stent occlusion in mid-term (six months) follow-up, which might be attributed to diffuse heterogeneous fibroplasia, smooth muscle proliferation, inflammation response and local neoatherosclerosis with the degradation of PLLA membrane.

Keywords
coronary artery perforation
covered stent
poly-L-lactic acid
biodegradable membrane
porcine
fibroplasia
neoatherosclerosis
Funding
2019QH1054/Startup Fund for scientific research, Fujian Medical University
2021J01758/Natural Science Foundation of Fujian Province
2020QNA035/Fujian Provincial Health Technology Project
Figures
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