摘要
目的探讨雷帕霉素和紫杉醇混合药物支架(RPES)在防治支架内再狭窄(ISR)的作用。方法以裸支架(BMS)、雷帕霉素药物涂层支架(RES,载药量为0.05mg/枚)作为对照组,通过涂层材料聚乳酸乙醇酸(PLGA)改性将疏水性雷帕霉素和亲水性紫杉醇融和制作雷帕霉素和紫杉醇混合药物支架(RPES,载药量为0.05mg/枚,雷帕霉素和紫杉醇均为0.025mg)。支架大小(直径2.0mm、长度15mm)一致。选10只家猪随机植入左冠状动脉前降支或回旋支(支架:动脉比率1.1～1.2:1.0),每只猪植入3枚,于支架植入后4周造影进行冠状动脉定量(QCA)分析和甲基丙烯酸甲酯包埋后切片,嗜伊红染色分析组织内膜增生状态。结果①与BMS组相比较,RES组和RPES组平均血管直径均显著改善(P<0.05),并且二者均无管腔丢失和径向狭窄;RPES组与RES组比较,平均血管直径差异无统计学意义(P>0.05)。②BMS组、RES组和RPES组均可见内膜完全覆盖支架,RES组和RPES组支架段内内膜最大厚度和内膜面积均显著小于BMS组(P<0.05)、血管腔面积显著大于BMS组(P<0.05)。RES组和RPES组比较,支架段内内膜最大厚度、内膜面积和血管腔面积差异均无统计学意义(P>0.05)。结论雷帕霉素和紫杉醇混合药物支架可有效预防再狭窄的发生发展,并且二者可能具有协同作用。
Objective To elucidate whether rapamycin and paclitaxel eluting stent can prevent the development of restenosis after stent embedding coronary artery of susscrota domestica for 4 weeks. Methods According to the ratio of stent vs artery （diameter 1. l--1.2 ： 1.0）, 30 stents （diameter --2.0 mm and length--15 mm; each group： n=10）, including bare metal stent （BMS）, rapamycin eluting stent （RES, dosage 0.05mg/every stent）, rapamycin and paclitaxel eluting stent （RPES, dosage 0.05 mg/every stent, raparnycin and paclitaxeI ratio 1.0 ： 1.0） blended by reshaping polylactic glycolic acid （PLGA）, were randomly implanted in the anterior descending coronary or circumflex branch coronary. After 4 weeks, coronary arteriography was fin/shed and the specimens were drawn, the quantity of coronary artery （QCA） was utilized to measure the average vascular diameter, vascular loss and radial restenosis. Then eosinophilic staining of specimens was performed to measure the most thickness, area of endarterium and area of vascular lumen embedded by stent. Results （1）Compared to BMS group, the average vascular diameter was significantly improved enosis （P〈0.05） were not found in both RES group （P〈0. 05）, both vascular loss （P〈0. 05） and radial rest- and RPES group; there were not statistic significances in average vascular diameter between RES group and RPES group （P〉0.05） ; （2）The inner membrane wrapped stent completely in three groups; both the most thickness （P〈0. 05） and area of endarterium （P〈0. 05） were significantly improved and the area of vascular lumen （P〈0.05） were significantly decreased more in both RES group and RPES group than those in BMS group （P〈0. 05）. However, there were not statistic significance in the most thickness, area of endarterium and the area of vascular lumen between RES group and RPES group. Conclusion Blending rapamycin and paclitaxel eluting stem prevents effectively the development of restenosis, besides, rapamycin
