In vivo distribution of c-myc antisense oligodeoxynucleotides local delivered by gelatin-coated platinum-iridium stents in rabbits and its effect on apoptosis

Background Post-stenting restenosis is a significant clinical problem, involving vascular smooth muscle cells (VSMCs) proliferation and apoptosis. It is reported that c-myc antisense oligodeoxynucleotides (ASODNs) local delivered by catheter can inhibit VSMCs proliferation. This study was designed to assess tissue distribution of c-myc ASODN local delivered using gelatin-coated platinum-iridium (Pt-Ir) stents, and its effect on apoptosis of VSMCs. Methods Gelatin-coated Pt-Ir stents that had absorbed caroboxyfluorescein-5-succimidyl ester (FAM) labeled c-myc ASODNs (550 μg per stent) were implanted into the right carotid arteries of 6 rabbits. Tissue samples were obtained at 45 minutes, 2 hours, and 6 hours. Tissue distribution of c-myc ASODNs was assessed by fluorescence microscopy. In addition, 32 rabbits were randomly divided into two groups. Rabbits in the control group (n=16) were implanted with gelatin-coated Pt-Ir stents, and those in the treatment group (n=16) were implanted with gelatin-coated stents that had absorbed c-myc ASODNs. 7, 14, 30, or 90 days (n=4, respectively, for each group) after the stenting procedure, the stented segments were harvested, and histopathological examinations were performed to calculate neointimal area and mean neointimal thickness. The expression of c-myc was assessed using in situ hybridization (ISH) and immunohistochemical methods. Apoptotic VSMCs were detected using terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) and transmission electron microscope (TEM). Results According to fluorescence microscopic results, FAM-labeled c-myc ASODNs were concentrated in the target vessel media at the 45 minutes time point, and then dispersed to the adventitia. Morphometric analysis showed that neointimal area and mean neointimal thickness increased continuously up to 90 days after stent implantation, but that total neointimal area and mean neointimal thickness were less in the treatment group than in the control group at all time points (P<0.0001). At day 7 and day 14 after stenting, there were no detectable apoptotic cells in either group. However, apoptotic cells were present in the neointima 30 and 90 days after stenting, and the number of apoptotic cells was less at 30 days than at 90 days. Meanwhile, c-myc ASODNs appeared to induce apoptosis in more cells in the treatment group than that in the control group. Typical apoptotic VSMCs were observable under TEM. The expression of c-myc was positive in the control group and negative or weakly positive in the c-myc ASODN treatment group, according to both ISH and immunohistochemical examination. Conclusion Gelatin-coated Pt-Ir stent mediated local delivery of c-myc ASODNs is feasible. The localization of c-myc ASODN is primarily in the target vessel walls. c-myc ASODNs can inhibit VSMCs proliferation and induce its apoptosis after local delivery in vivo.     

雷帕霉素洗脱支架抑制猪颈动脉成形术后近期再狭窄的实验研究

目的:研究自膨式雷帕霉素洗脱支架防治猪颈动脉血管成形术后近期再狭窄的有效性安全性,及其作用机制.方法:国产小型猪6只,分别行双侧颈总动脉球囊扩张损伤后,随机分为对照组(裸支架组)和实验组(雷帕霉素洗脱支架组),各置入6枚.术后4周重复动脉造影后处死动物.取出支架段血管,测算支架处血管管腔面积、新牛内膜厚度与面积及管腔狭窄百分比以评价内膜增生程度.应用TUNEL法检测新生内膜细胞凋亡指数(apoptotic index,AI),免疫组化检测血管平滑肌细胞中增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)、Bcl-2、Bax表达水平.结果:雷帕霉素洗脱支架组支架内管腔面积大于裸支架组(P<0.05);新生内膜面积小于裸支架组(P<0.05);新生内膜厚度小于裸支架组(P<0.05);细胞凋亡多于裸支架组(P<0.05):PCNA阳性细胞及Bcl-2表达低于裸支架组(P<0.05);Bax表达高于裸支架组(P<0.05).结论:雷帕霉素洗脱支架能抑制新生内膜形成.在支架植入后4周能预防猪颈动脉血管成形术后近期再狭窄的形成.可能通过上调Bax,下调Bcl-2的表达.从而抑制血管平滑肌细胞增殖发挥作用.     

光学相干断层成像评价药物洗脱支架与金属裸支架治疗后的内膜增殖

目的应用光学相干断层成像(OCT)技术比较冠状动脉内雷帕霉素药物洗脱支架(DES)和金属裸支架(BMS)治疗后内膜增殖情况。方法对19例冠心病经冠状动脉内支架置入治疗后5~93个月的患者进行冠状动脉造影复查,造影后对21支血管23个支架进行OCT成像检查。DES术后6~10个月为药物支架A组;BMS术后5~10个月为金属裸支架B组;BMS术后23~93个月为金属裸支架C组。应用OCT成像技术比较3组支架之间内膜增殖情况。结果OCT成像结果显示3组之间有关支架后最大内膜增殖厚度、血管腔直径和截面积丢失及直径和截面积再狭窄等方面差异有统计学意义。其中A组内膜最大增殖厚度明显小于B组(0·20mm±0·13mmvs0·81mm±0·46mm,P=0·019)和C组(0·91mm±0·27mm,P=0·007);A组血管腔直径丢失明显小于B组(0·27mm±0·17mmvs1·12mm±0·79mm,P=0·009)和C组(1·20mm±0·31mmP=0·013);A组直径再狭窄明显小于B组(8%±4%vs36%±24%,P=0·009)和C组(35%±6%,P=0·017);A组截面积丢失明显小于B组(1·14mm2±0·9mm2vs3·96mm2±2·62mm,P=0·009)和C组(4·66mm2±1·66mm2,P=0·006);A组截面积再狭窄明显小于B组(P=0·017)和C组(P=0·009)。置入的13个BMS支架,几乎所有支架支撑杆表面均有内膜覆盖,而置入DES后内膜增殖较少,部分支架支撑杆表面即使在支架术后29个月仍然没有内膜覆盖。结论OCT成像技术可清晰地显示支架支撑杆及表面内膜增殖情况,对评价药物洗脱支架的治疗效果具有重要意义。     

A Novel Antisense Oligodeoxynucleotide Targeting Caspase-3 mRNA Prevents PC-12 Cell Apoptosis Induced by Aβ_(25-35)

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莪术有效成分涂层支架对猪冠状动脉内膜新生的长期影响

Objective

To examine the effect of the zedoary essential component-eluting stent (ZES) on a porcine coronary neointimal formation.

Methods

ZES, sirolimus-eluting stents (SES), and bare metal stents (BMS) were randomly implanted in three different major epicardial vessels in 36 balloon-injured pigs. Coronary angiography, optical coherence tomography, and histomorphological analysis were used to determine antihyperplasia effects.

Results

ZES and SES had a significantly larger lumen diameter and area, and reduced diameter and area of stenosis in arteries at 30 and 90 days compared with arteries implanted with BMS (P<0.01). Histomorphometric analysis showed moderate inflammatory responses, such as infiltration of mononuclear cells, lymphocytes, and multinucleated giant cells in some arteries with SES compared with ZES (P<0.05). Injury scores were not different among the three groups at 30 and 90 days. The endothelialization score in the SES group was 2.69±0.42 at 30 days and 2.83±0.39 at 90 days compared with the ZES and BMS groups (both were 3.00±0.00 at either 30 or 90 days, P<0.05). Well developed endothelium was observed in the ZES group, while incomplete endothelium and inflammatory cells were observed with stent struts partly naked at the vessel lumen in the SES group.

Conclusion

The ZES inhibits neointimal hyperplasia with good endothelia coverage in the porcine balloon injury coronary model.     

雷公藤内酯醇洗脱支架预防猪冠脉支架内再狭窄

目的 观察雷公藤内酯醇洗脱支架植入后对冠脉支架内再狭窄的影响,初步探讨其预防支架内再狭窄的作用机制.方法 采用20只国内杂种幼猪,分别植入雷公藤内酯醇洗脱支架和普通支架(裸金属支架)各10个.术后28 d取冠脉行组织病理检查内膜增生程度,并用免疫组化方法 检测内膜平滑肌细胞中增殖细胞核抗原(PCNA)和血小板源性生长因子(PDGF)的表达.结果 支架部位血管腔面积裸支架组小于雷公藤内酯醇组、支架内增生内膜面积及内膜增生程度裸支架组大于雷公藤内酯醇组(P＜0.05).支架植入后28 d两组血管新生内膜均可见增殖细胞(PCNA阳性细胞),雷公藤内酯醇组比裸支架组明显减少,PDGF阳性细胞数雷公藤内酯醇组亦明显少于裸支架组,差异均有显著性(P＜0.05).结论 雷公藤内酯醇洗脱支架能抑制新生内膜的形成,其通过影响PDGF的表达,抑制新生内膜平滑肌细胞的增殖,从而减少支架内再狭窄的发生.     

光学相干断层成像技术分析犬冠状动脉支架术后内膜增殖情况

目的通过和组织学分析进行对比,评价在活体应用光学相干断层成像分析犬冠状动脉支架术后内膜增殖程度的精确性。方法选取15只杂种犬为研究对象,每只犬冠状动脉植入一枚金属裸支架,3个月后复查冠状动脉造影、光学相干断层成像(OCT)、组织学分析,分别应用OCT和高倍电子显微镜定量分析内膜增殖情况,测量两组靶血管支架内膜增殖最严重处的平均内膜厚度(mm)、直径狭窄程度(%)、血管残腔面积(mm2)、新生内膜面积(mm2)、支架面积(mm2)、面积狭窄程度(%)。最终将OCT和组织学测量结果进行统计学分析。结果 15只动物均完成实验,OCT及组织学两种方法测量支架面积(mm2)差异无显著性(5.01±0.79 vs 4.99±0.81,P>0.05),OCT测量新生内膜厚度(mm)和面积(mm2)明显小于组织学测量(0.19±0.08 vs 0.22±0.10,1.52±0.49 vs 1.85±0.78,P<0.05),OCT测量残余管腔面积明显大于组织学测量(3.50±0.66 vs 3.15±0.43,P<0.05)。OCT测量新生内膜厚度(R2=0.767)、新生内膜面积(R2=0.537)和支架面积(R2=0.528)时和组织学测量有良好的直线相关性,测量残余管腔面积(R2=0.307)时直线相关性较低。所有支架金属丝均完全内皮化,无血栓、夹层及血管正性重构形成。结论在活体上,OCT能够精确并反复分析支架内膜增殖情况,而测量残腔管腔面积时,OCT和组织学分析直线相关性较低。     

32P球囊内放射治疗预防动脉损伤后新生内膜过度增生

目的：选用家兔颈动脉球囊损伤模型观察放射性^32P液体球囊血管内放射治疗对损伤后新生内膜过度增生的抑制作用。方法：健康家兔40只制作颈动脉球囊损伤模型，随机分成4组：10、20和40GY放射剂量治疗组和对照组。分别于术后3、7、14、28和56天处死动物，取颈动脉标本HE染色、原位标记凋亡细胞（TUNEL）和增殖细胞核抗原（PCNA）免疫组化染色，应用光学显微镜和计算机图像分析系统对切片进行图像分析．计算动脉中膜血管平滑肌细胞凋亡率、PCNA阳性率、内膜和中膜厚度及面积、残余管腔面积。结果：球囊损伤后动脉中膜平滑肌细胞开始增殖．并向内膜下迁移，其凋亡率和PCNA细胞阳性率均在伤后7天达到高峰。各治疗组各时间段血管平滑肌细胞凋亡率高于对照组（P〈0．01）．PCNA细胞阳性率低于对照组（P〈0．01），20GY和40GY组相似，但都优于10GY组（P〈0．01）；伤后28天始血管内膜和中膜增厚．面积增加，残余管腔面积缩小，各治疗组伤后28天始血管内膜、中膜增厚面积增加和残余管腔面积缩小明显改善（P〈0．01），20GY和40GY组相似，但都优于10GY组（P〈0．01）。结论：放射性^32P液体球囊血管内放射治疗可以明显抑制球囊损伤后动脉血管壁平滑肌细胞的增殖和迁移．减少新生内膜过度增生．预防管腔狭窄。     

脂质体介导c-myc反义寡核苷酸诱导HeLa细胞凋亡的实验研究

目的体外研究C-MYC反义寡核苷酸(ASODN)对人宫颈癌HELA细胞凋亡的影响,寻求提高肿瘤细胞放射敏感性的方法。方法免疫组化、流式细胞术、半定量RT-PCR法鉴定ASODN的有效性;GIEMSA染色、流式细胞术检测凋亡指数(AI)、DNA LADDER检测细胞凋亡。结果转染后,免疫组化结果显示C-MYC蛋白表达降低;半定量RT-PCR结果显示C-MYC MRNA表达较空白对照组及阴性对照组明显减弱(P<0.05)。GIEMSA染色可见凋亡小体;流式细胞术结果显示转染后凋亡指数为(10.29±0.66)%,转染ASODN(C-MYC)联合放射的凋亡指数为(16.83±0.57)%,均明显高于空白对照组(1.79±0.19)%(P<0.05);DNA LADDER呈现具有凋亡特征的梯带。结论本实验所设计的ASODN能有效地抑制C-MYC基因的表达;转染ASODN(C-MYC)能够显著增加HELA细胞凋亡,从而提高肿瘤细胞的放射敏感性。     

量子点标记与绿色荧光素标记对survivin反义寡核苷酸生物功能影响的比较

目的 观察量子点和绿色荧光素分别标记的survivin反义寡核苷酸(ASODN)转染人乳腺癌细胞株MCF-7后,在标记存在时间、survivin的表达及细胞增殖、凋亡方面有无差异.方法 将量子点和绿色荧光素分别标记的survivin ASODN通过脂质体转染MCF-7,MTT法检测细胞生长抑制率,RT-PCR检测survivin mRNA,Western blot检测survivin蛋白表达,流式细胞仪分析细胞凋亡率变化,荧光倒置显微镜观察细胞内荧光物质分布.结果 量子点与绿色荧光素分别标记的survivin ASODN作用MCF-7后,survivin mRNA和survivin蛋白表达均下降,但两者间无显著差异(P＞0.05).两者细胞生长抑制率、凋亡率间无显著差异(P＞0.05).转染后4 d绿色荧光素标记组细胞内荧光消失,而量子点标记组荧光1周仍存在.结论 量子点标记survivin ASODN与绿色荧光素标记比较,对survivin的表达及细胞增殖、凋亡方面无差异,而标记更稳定,存在时间更长.     

血管支架置入术后细胞凋亡的实验研究

目的 观察血管支架置放术后不同时间段血管壁增殖与细胞凋亡的变化过程.方法 对16只家兔进行颈动脉内膜损伤及支架置放术.于术后即刻、7、14、28 d,4个时间点处死.处死后取出支架部位及球囊损伤部位颈动脉血管段,进行细胞增殖与凋亡检测,包括电镜检查,病理切片HE染色及免疫组化分析细胞增殖核抗原(PCNA),Western印迹检测凋亡相关基因p53、bcl-2.结果 HE染色显示内膜损伤及支架置入血管在各时间点,血管壁全层均表现轻度不均匀增厚.PCNA在支架置入组与内膜损伤组都表现为术后即刻为阴性,术后7 d为阳性表达,术后14 d表达最强,术后28 d表达为阴性;正常血管PCNA表达为阴性.电镜检查,内膜损伤及支架置放术都表现为较多胶原基质及纤维,细胞成分较多,可见含丰富分泌颗粒的细胞,可见吞噬细胞,术后28 d标本可见凋亡的成纤维细胞.凋亡相关基因表达:p53,正常颈动脉组织可见p63表达;支架组术后即刻可见表达,术后7 d表达减弱,术后14 d表达可见,术后28 d表达最强;内膜损伤组术后即刻、术后7 d均较弱,术后14 d表达稍有增加,术后28 d表达最强;bcl-2,正常颈动脉组织未见表达;支架组术后即刻未见表达,术后7 d表达增强,术后14 d及术后28 d未见表达;内膜损伤组术后即刻未见表达,术后7 d表达增强,术后14 d有微量表达,术后28 d未见表达.结论 血管支架置入术后可见异常的凋亡现象,术后早中期细胞增殖活性较高,后期出现细胞凋亡从而抑制细胞的增殖.     

Short-term safety and efficacy of the biodegradable iron stent in mini-swine coronary arteries

Background To overcome the drawbacks of permanent years. The bioabsorbable polymer vascular scaffold （BVS） stents, biodegradable stents have been studied in recent was the first bioabsorbable stent to undergo clinical trials, demonstrating safety and feasibility in the ABSORB studies. Iron can potentially serve as the biomatedal for biodegradable stents. This study aimed to assess the short4erm safety and efficacy of a biodegradable iron stent in mini-swine coronary arteries. Methods Eight iron stents and eight cobalt chromium alloy （VISION） control stents were randomly implanted into the LAD and RCA of eight healthy mini-swine, respectively. Two stents of the same metal base were implanted into one animal. At 28 days the animals were sacrificed after coronary angiography, and histopathological examinations were performed. Results Histomorphometric measurements showed that mean neointimal thickness （（0.46±0.17） mm vs. （0.45±0.18） mm, P=0.878）, neointimal area （（2.55±0.91） mm2 vs. （3.04±1.15） mm2, P=0.360） and percentage of area stenosis （（44.50±11.40）% vs. （46.00±17.95）%, P=0.845） were not significantly different between the iron stents and VISION stents. There was no inflammation, thrombosis or necrosis in either group. The scanning electron microscopy （SEM） intimal injury scores （0.75±1.04 vs. 0.88±0.99, P=0.809） and number of proliferating cell nuclear antigen （PCNA） positive staining cells were not significantly different between the two groups. The percentage of neointimal coverage by SEM examination was numerically higher in iron stents than in VISION stents （（84.38±14.50）% vs. （65.00±22.04）%, P=0.057）, but the difference was not statistically significant. Iron staining in the tissue surrounding the iron stents at 28 days was positive and the vascular wall adjacent to the iron stent had a brownish tinge, consistent with iron degradation. No abnormal histopathological changes were detected in coronary arteries or major organs. Conclusions The biodegradable iron stent has good biocompatibility and short-term safety and efficacy in the mini- swine coronary artery. Corrosion of iron stents is observed at four weeks and no signs of organ toxicity related to iron degradation were noted.     

血管内支架在冠状动脉复杂病变成形术中的临床应用

本文报道了 31例冠心病患者冠状动脉复杂病变在经皮冠状动脉成形术 (PTCA)并发急性血管内闭塞、内膜严重撕裂、术后显著残留狭窄及短期内再狭窄等的情况下行冠状动脉内支架植入术 (CASI) ,均获成功 ,术后急性血管闭塞和内膜撕裂征象消失 ,残留狭窄及再狭窄解除 ,未出现出血和穿刺部位血管并发症及CASI后亚急性血栓形成。随访 2 6例 ,1例术后 1 3天发生猝死 ,2例因胸痛复发经造影证实支架血管再狭窄 ,再次球囊扩张后再狭窄有所改善 ,余 2 3例冠状动脉造影示支架血管正常 ,结果表明 ,冠心病复杂冠状动脉病变行CASI是解除PTCA急性并发症的安全有效的方法 ,亦有助于PTCA后再狭窄的防治。     

雷公藤内酯醇洗脱支架抑制支架内再狭窄及对PCNA、P27kip1表达的影响

目的 研究雷公藤内酯醇洗脱支架对冠脉支架植入术后再狭窄的有效性及安全性,及其对冠脉增殖细胞核抗原(PCNA)、P27kip1表达的影响.方法 采用20只国内杂种幼猪,随机分成裸支架组和雷公藤内酯醇洗脱支架组,每组各植入支架10枚.比较支架植入后4周各组的冠脉造影、组织病理学、免疫组化及血生化结果.结果 雷公藤内酯醇洗脱支架组支架内最小内径相似,大于裸支架组(P＜0.05);雷公藤内酯醇洗脱支架组新生内膜面积小于裸支架(P＜0.05).雷公藤内酯醇洗脱支架组PCNA阳性细胞少于裸支架组(P＜0.05),而P27kip1表达多于裸支架组(P＜0.05).未发现明显的毒副作用.结论 雷公藤内酯醇能抑制新生内膜的形成,在支架植入后4周能预防再狭窄的形成,可能通过影响PCNA和P27kip1蛋白的表达抑制血管平滑肌细胞增殖发挥作用.     

An experimental study of inferior vena caval stent in canine

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Investigation of long-term implantation of BuMA stent in a porcine coronary model

Background  Stent-based delivery of sirolimus has been shown to reduce neointimal hyperplasia significantly. However, the long-term effect of the polymer is thought to initiate and sustain an inflammatory response and contribute to the occurrence of late complications. Our study aimed to evaluate the efficacy and safety of the BuMA biodegradable drug-coated sirolimus-eluting stent (BSES) for inhibiting neointimal hyperplasia in a porcine coronary model.

Methods  Four types of stents were implanted at random in different coronary arteries of the same pig: BSES (n=24), bare metal stent (BMS) (n=24), biodegradable polymer coated stent without drug (PCS) (n=24) and only poly (n-butyl methacrylate) base layer coated stent (EGS) (n=23). In total, 26 animals underwent successful random placement of 95 oversized stents in the coronary arteries. Coronary angiography was performed after 28 days, 90 days and 240 days of stent implantation. After 14 days, 28 days, 90 days and 240 days, 6 animals at each timepoint were sacrificed for histomorphologic analysis.

Results  The 28-day, 90-day and 240-day results of quantitative coronary angiography (QCA) showed reduction in luminal loss (LL) in the BSES group when compared with the BMS group;  (0.20±0.35) mm vs. (0.82±0.51) mm (P=0.035), (0.20±0.30) mm vs. (0.93±0.51) mm (P=0.013), and (0.18±0.16) mm vs. (0.19±0.24) mm (P=0.889), respectively. By 28-day, 90-day and 240-day histomorphomeric analysis results, there was also a corresponding significant reduction in neointimal tissue proliferation with similar injury scores of BSES compared with the BMS control; average neointimal area (0.90±0.49) mm² vs. (2.16±1.29) mm² (P=0.049), (1.53±0.84) mm² vs. (3.41±1.55) mm² (P=0.026), and (2.43±0.95) mm² vs. (3.12±1.16) mm² (P=0.228), respectively. High magnification histomorphologic examination revealed similar inflammation scores and endothelialization scores in both the BSES and BMS groups.

Conclusions  The BuMA biodegradable drug-coated sirolimus-eluting stents can significantly reduce neointimal hyperplasia and in-stent restenosis. Re-endothelialization of the BuMA stent is as good as that of the BMS in the porcine coronary model due to the reduced inflammation response to the BuMA stent.

     

反义c-myc寡脱氧核苷酸对家兔髂总动脉损伤后内膜增生的影响

目的：观察反义c-myc寡脱氧核苷酸(ASODN)对家兔髂总动脉损伤后内膜增生的影响，探讨其防治再狭窄的潜在作用。方法：通过pluronic gel缓释系统和Lipofeclin转染导入系统，将c-myc ASODN作用于家兔髂总动脉损伤后的血管外膜，3周后对所取的血管节段进行组织切片和苏木精-伊红染色，在显微镜下进行形态学观察，并采用图像分析系统进行图像分析，计算出内膜，中膜(I/M)面积比和I／M厚度比，并进行统计学处理。结果：c-myc ASODN可明显抑制内膜增生，而正义c-myc ODN对内膜增生无影响。结论：c-myc ASODN以序列特异性方式抑制了新生内膜的形成。     

缠绕型和管型冠状动脉内支架在冠心病治疗中的应用

目的　探讨应用缠绕型和管型冠状动脉内支架治疗冠心病的效果。方法　对 2 3例冠心病患者根据不同情况植入冠状动脉内支架 ,其中DeNovo支架 17个 ,Suboptimal支架 6个 ,Bail-out支架 2个。结果　 2 3例患者 2 5支血管植入 2 5个冠状动脉内支架。其中缠绕型支架 9个 ,包括Gianturco -Robin支架2个 ,XT支架 7个 ;管型支架植入 16个 ,均为NIR支架。植入前降支 15个 ,回旋支 2个 ,右冠状动脉 8个。所有支架植入均获得成功。 3例心绞痛复发的患者经造影证实为再狭窄 ,其中XT支架 1个 ,NIR支架 2个 ,总的再狭窄率为 12 % ,缠绕型和管型支架的再狭窄率分别为 11%和 12 .5 %。结论　冠状动脉内支架为治疗PTCA术后急性冠状动脉闭塞、降低再狭窄率的有效措施 ;根据不同的病变合理选择缠绕型和管型支架可提高支架植入的成功率 ,减少并发症。     

经皮冠状动脉腔内支架置入术治疗冠心病

目的:评估冠状动脉内支架置入术的效果。方法:回顾性分析1996年2月～2000年2月我院接受冠状动脉内支架置入术的120例病人的治疗效果。结果:在183处病变共置入支架125只。在未经介入性治疗的病变置入支架(De novo stenting)101只,PTCA结果不理想(suboptimal)置入支架19只,2例PTCA并发夹层,濒临闭塞时紧急置入支架(Bail-out stenting)2只,在再狭窄病变置入支架3只。置入支架平均直径3.00±0.69mm,平均长度18.15±10.26mm。手术即刻成功率98.4％,主要并发症率为1.6％((2例AMI)。结论:冠脉内支架置入术是治疗冠心病的一种安全有效的介入性治疗技术,其成功率高,并发症少。     

血管内支架在冠状动脉复杂病变成形术中的临床应用

目的探讨血管内支架在冠状动脉复杂病变成形术中的应用效果及价值.方法对冠心病患者复杂冠状动脉病变在经皮穿刺冠状动脉成形术(PTCA)并发急性血管内闭塞、内膜严重撕裂、术后显著残留狭窄及短期内再狭窄等情况下进行了血管内支架植入术(CASI).结果31例患者CASI均获成功,术后急性血管闭塞和内膜撕裂征象消失,残留狭窄及再狭窄解除,未出现出血和穿刺部位血管并发症及CASI后亚急性血栓形成.随访16例,1例术后13天发生猝死;2例因胸痛复发经造影证实支架血管再狭窄,再次球囊扩张后再狭窄改善;余13例冠状动脉造影示支架血管正常.结论冠心病复杂冠状动脉病变行CASI是解除PTCA急性并发症的安全、有效和可行的方法,并有助于PTCA后再狭窄的防治.