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首页> 外文期刊>Circulation: An Official Journal of the American Heart Association >Intracoronary optical coherence tomography and histology at 1 month and 2, 3, and 4 years after implantation of everolimus-eluting bioresorbable vascular scaffolds in a porcine coronary artery model: an attempt to decipher the human optical coherence tomography images in the ABSORB trial.
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Intracoronary optical coherence tomography and histology at 1 month and 2, 3, and 4 years after implantation of everolimus-eluting bioresorbable vascular scaffolds in a porcine coronary artery model: an attempt to decipher the human optical coherence tomography images in the ABSORB trial.

机译：在猪冠状动脉模型中植入依维莫司洗脱的可生物吸收的血管支架后1个月，2年，3年和4年的冠状动脉内光学相干断层扫描和组织学：尝试在ABSORB试验中破译人的光学相干断层扫描图像。

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BACKGROUND: With the use of optical coherence tomography (OCT), alterations of the reflectance characteristics of everolimus-eluting bioresorbable vascular scaffold (BVS) struts have been reported in humans. In the absence of histology, the interpretation of the appearances of the struts by OCT remains speculative. We therefore report OCT findings with corresponding histology in the porcine coronary artery model immediately after and at 28 days and 2, 3, and 4 years after BVS implantation. METHODS AND RESULTS: Thirty-five polymeric BVS (3.0x12.0 mm) were singly implanted in the main coronary arteries of 17 pigs that underwent OCT and were then euthanized immediately (n=2), at 28 days (n=2), at 2 years (n=3), at 3 years (n=5), or at 4 years (n=5) after implantation. All BVS-implanted arteries in these animals were evaluated by histology except for 5 arteries examined at 2 years with gel permeation chromatography to assess the biodegradation of the polymeric device. Fourteen arteries with BVS from an additional 6 pigs were examined by gel permeation chromatography at 1 (n=1), 1.5 (n=2), and 3 (n=2) years. Corresponding OCT and histology images were selected with the distal and proximal radiopaque markers used as landmarks. At 28 days, by OCT, 82% of struts showed sharply defined, bright reflection borders, best described as a box-shaped appearance. Histologically, all struts appeared intact with no evidence of resorption. At 2 years, by OCT, 60+/-20 struts were discernible per BVS with 80.4% of the strut sites as a box-shaped appearance. Despite their defined appearance by OCT, by histology, these structures appeared to be composed of proteoglycan, with polymeric material being at such low level as to be no longer quantifiable by chromatography. At 3 years, by OCT, recognizable struts decreased to 28+/-9 struts per BVS: 43.7% showed dissolved black box; 34.8%, dissolved bright box; 16.1%, open box; and 5.4%, preserved box appearance. Histology shows that connective tissue cells within a proteoglycan-rich matrix replaced the areas previously occupied by the polymeric struts and coalesced into the arterial wall. At 4 years, by OCT, 10+/-6 struts were recognizable as either dissolved black or dissolved bright box. In histology, these struts are minimally discernible as foci of low-cellular-density connective tissue. Relative to the prediction of histological type by OCT appearance, the preserved box appearance of OCT corresponds well with 2-year histology (86.4%), whereas the dissolved bright and black box appearances correspond to 3-year histology (88.0% and 90.7%, respectively). Struts indiscernible by OCT correspond to the integrated strut footprints seen at 4 years (100%). CONCLUSIONS: Struts that are still discernible by OCT at 2 years are compatible with largely bioresorbed struts, as demonstrated by histological and gel permeation chromatography analysis. At 3 and 4 years, both OCT and histology confirm complete integration of the struts into the arterial wall.
机译：背景：使用光学相干断层扫描（OCT），已报道了依维莫司洗脱的生物可吸收血管支架（BVS）支杆的反射特性发生变化。在没有组织学的情况下，OCT对支柱外观的解释仍然是推测性的。因此，我们在BVS植入后28天，2天，3年和4年立即以及在猪冠状动脉模型中报告了具有相应组织学的OCT发现。方法和结果：35只聚合体BVS（3.0x12.0 mm）被单独植入17头经过OCT的猪的主要冠状动脉中，然后在第28天（n = 2）立即被安乐死（n = 2），植入后2年（n = 3），3年（n = 5）或4年（n = 5）。通过组织学评估这些动物中所有BVS植入的动脉，除了在2年时用凝胶渗透色谱法检查的5条动脉以评估聚合物装置的生物降解。在1年（n = 1），1.5年（n = 2）和3年（n = 2）通过凝胶渗透色谱法检查了另外6头猪的BVS的14条动脉。以远端和近端不透射线标记物为界标，选择相应的OCT和组织学图像。根据OCT的第28天，有82％的支杆显示出清晰，明亮的反射边界，最能形容为盒状外观。从组织学角度看，所有支杆均完好无损，没有再吸收的迹象。根据OCT的第2年，每个BVS可以识别出60 +/- 20个支杆，其中80.4％的支杆部位呈盒状。尽管通过OCT，通过组织学已确定其外观，但这些结构似乎仍由蛋白聚糖组成，聚合材料的含量低至无法通过色谱法定量。根据OCT的第3年，可识别的支撑减少到每个BVS的28 +/- 9个支撑：43.7％显示溶解的黑匣子; 34.8％，溶解了亮框; 16.1％，开箱;和5.4％，保留了盒子外观。组织学表明，富含蛋白聚糖的基质内的结缔组织细胞取代了先前由聚合物支杆占据并合并到动脉壁中的区域。根据OCT的规定，在4年时，可以识别出10 +/- 6的支杆是溶解的黑色盒子还是溶解的亮盒子。在组织学上，这些支杆很少被识别为低细胞密度结缔组织的病灶。相对于通过OCT外观预测的组织学类型，OCT保留的盒子外观与2年组织学的比例非常合适（86.4％），而溶解的亮框和黑盒子外观则与3年组织学的比例相对应（88.0％和90.7％，分别）。 OCT无法区分的支撑杆对应于4年时观察到的整体支撑杆足迹（100％）。结论：如组织学和凝胶渗透色谱分析所示，在2年内仍可通过OCT识别的支撑杆与大部分可生物吸收的支撑杆兼容。在3年和4年时，OCT和组织学均证实支杆已完全整合到动脉壁中。

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