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Cardiovascular Research 2004 63(4):617-624; doi:10.1016/j.cardiores.2004.04.029
© 2004 by European Society of Cardiology
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Copyright © 2004, European Society of Cardiology

Long-term effects of polymer-based, slow-release, sirolimus-eluting stents in a porcine coronary model

Andrew J Cartera,*, Meenakshi Aggarwalb, Gregory A Kopiac, Fermin Tiod, Philip S Tsaob, Ron Kolatae, Alan C Yeungb, Gerald Llanosc, John Dooleyc and Robert Faloticoc

aProvidence Heart and Vascular Institute, Providence St. Vincent Medical Center, 9205 SW Barnes Road, Portland, OR 97225-5218, USA
bStanford University Medical Center, Stanford, CA, USA
cCordis Co., Warren, NJ, USA
dUniversity of Texas at San Antonio Health Sciences Center, San Antonio, TX, USA
eEthicon Endo-Surgery, Inc., Cincinatti, OH, USA

* Corresponding author. Tel.: +1-503-2165206; fax: +1-503-2162112. Email address: acarter{at}providence.org

Background: Stent-based delivery of sirolimus (SRL) has shown reduction in neointimal hyperplasia and restenosis. The purpose of this study was to evaluate the chronic vascular response and the expression of cell cycle regulators after SRL-eluting stent implantation in a porcine coronary model. Methods: Forty-nine pigs underwent placement of 109 oversized stents (control, n=54, SRL (140 µg/cm2), n=55) in the coronary arteries with histologic analysis and Western blot (PCNA, p27kip1, CD45, MCP-1, IL-2, IL-6, TNF-β) at 3, 30, 90 or 180 days. Results: At 3 days, the mean thrombus area was similar for control (0.38±0.19 mm2) and SRL (0.29±0.09 mm2) stents. After 30 days, the mean neointimal area was significantly less for the SRL (1.40±0.35 mm2) versus the control stents (2.94±1.28 mm2, p<0.001). At 90 and 180 days, the mean neointimal area was similar for the SRL (3.03±0.92 and 3.34±0.99 mm2) as compared with control stents (3.45±1.09 and 3.65±1.23 mm2). Western blot analysis demonstrated an increased expression of p27kip1 in the vessel wall at 90 days for the SRL versus control stents (p=0.05) but with increased levels of PCNA in the SRL as compared with control stents (p=0.003). Conclusion: SRL-eluting stents favorably modulate neointimal formation for 30 days in the porcine coronary model. Long-term inhibition of neointimal hyperplasia is not sustained presumably due to delayed cellular proliferation despite increased levels of the cyclin-dependent kinase p27kip1 in the vessel wall.

KEYWORDS Stents; Restenosis; Smooth muscle; Cell cycle

Time for primary review 19 days


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