Journal Article

Neoatherosclerosis development following bioresorbable vascular scaffold implantation in diabetic and non-diabetic swine

van Ditzhuijzen, Nienke S., Sorop, Oana, Regar, Evelyn, van den Heuvel, Mieke, Murawska, Magdalena, Bouma, Brett, Garcia-Garcia, Hector M., Witberg, Karen, van Duin, Richard W. B., van Soest, Gijs, Zijlstra, Felix, Krabbendam-Peters, Ilona, van Beusekom, Heleen M. M., Ligthart, Jurgen, Villiger, Martin, Duncker, Dirk-Jan, Serruys, Patrick W., Kurata, Mie

2017

Overview

DM remains a risk factor for poor outcome after stent-implantation, but little is known if and how DM affects the vascular response to BVS. The aim of our study was to examine coronary responses to bioresorbable vascular scaffolds (BVS) in swine with and without diabetes mellitus fed a 'fast-food' diet (FF-DM and FF-NDM, respectively) by sequential optical coherence tomography (OCT)-imaging and histology. Fifteen male swine were evaluated. Eight received streptozotocin-injection to induce DM. After 9 months (M), 32 single BVS were implanted in epicardial arteries with a stent to artery (S/A)-ratio of 1.1:1 under quantitative coronary angiography (QCA) and OCT guidance. Lumen, scaffold, neointimal coverage and composition were assessed by QCA, OCT and near-infrared spectroscopy (NIRS) pre- and/or post-procedure, at 3M and 6M. Additionally, polarization-sensitive (PS)-OCT was performed in 7 swine at 6M. After sacrifice at 3M and 6M, histology and polymer degradation analysis were performed. Late lumen loss was high (~60%) within the first 3M after BVS-implantation (P<0.01 FF-DM vs. FF-NDM) and stabilized between 3M and 6M (<5% change in FF-DM, ~10% in FF-NDM; P>0.20). Neointimal coverage was highly heterogeneous in all swine (DM vs. NDM P>0.05), with focal lipid accumulation, irregular collagen distribution and neointimal calcification. Likewise, polymer mass loss was low (~2% at 3M, ~5% at 6M;P>0.20) and not associated with DM or inflammation. Scaffold coverage showed signs of neo-atherosclerosis in all FF-DM and FF-NDM swine, scaffold polymer was preserved and the vascular response to BVS was not influenced by diabetes.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Absorbable Implants - adverse effects / Angiography / Animals / Arteries / Arteriosclerosis / Atherosclerosis / Atherosclerosis - diagnostic imaging / Atherosclerosis - etiology / Atherosclerosis - metabolism / Atherosclerosis - pathology / Biocompatibility / Biology and Life Sciences / Biomarkers / Biomedical materials / Biopsy / Calcification / Calcification (ectopic) / Cardiology / Cholesterol / Collagen / Collagen - metabolism / Comparative analysis / Coronary vessels / Coronary Vessels - pathology / Development and progression / Diabetes / Diabetes mellitus / Diabetes Mellitus - metabolism / Diabetes Mellitus - pathology / Diabetics / Disease Models, Animal / Fast food / Food / Histology / I.R. radiation / Implantation / Implants / Infrared spectra / Infrared spectroscopy / Laboratory animals / Livestock / Male / Medical imaging / Medicine and Health Sciences / Metabolism / Near infrared radiation / Near infrared spectroscopy / Neointima - metabolism / Neointima - pathology / Optical Coherence Tomography / Physiological aspects / Polymers / Research and Analysis Methods / Risk factors / Scaffolds / Spectrum analysis / Stents / Streptozocin / Surgical implants / Swine / Thrombosis / Tissue Scaffolds - adverse effects / Tomography / Tomography, Optical Coherence / Veins & arteries