Endovascular procedures cause transient endothelial injury but do not disrupt mature neointima in Drug Eluting Stents

Abstract

Extensive application of coronary intravascular procedures has led to the increased need of understanding the injury inflicted to the coronary arterial wall. We aimed to investigate acute and prolonged coronary endothelial injury as a result of guidewire use, repeated intravascular imaging and stenting. These interventions were performed in swine (N = 37) and injury was assessed per coronary segment (n = 81) using an Evans Blue dye-exclusion-test. Scanning electron microscopy and light microscopy were then used to visualize the extent and nature of acute (<4 hours) and prolonged (5 days) endothelial injury. Guidewire and imaging injury was mainly associated with denudation and returned to control levels at 5 days. IVUS and OCT combined (Evans Blue staining 28 ± 16%) did not lead to more acute injury than IVUS alone (33 ± 15%). Stent placement caused most injury (85 ± 4%) and despite early stent re-endothelialization at 5 days, the endothelium proved highly permeable (97 ± 4% at 5 days; p < 0.001 vs acute). Imaging of in-stent neointima at 28 days after stent placement did not lead to neointimal rupture. Guidewire, IVUS and OCT induce acute endothelial cell damage, which does not increase during repeated imaging, and heals within 5 days. Interestingly, endothelial permeability increases 5 days post stenting despite near complete re-endothelialization.

Prior antiplatelet therapy in patients undergoing endovascular treatment for acute ischemic stroke: Results from the MR CLEAN Registry

“…In the propensity-score-matched cohort, no significant difference in sICH risk was observed between patients who were on prior antiplatelet therapy and those not on prior antiplatelet therapy (74/937 [7.9%] vs. 27/477 [5.6%]; aOR 1.47, 95% CI 0.86-2.49; Table 2). Also, no associations were found between prior antiplatelet therapy and functional outcome (median mRS 4 [IQR: 2-6] vs. 4 [2][3][4][5][6]; acOR 0.87, 95% CI 0.65-1.16; Figure 2), successful reperfusion (aOR 1.23, 95% CI 0.77-1.97), mortality (aOR 1.15, 95% CI 0.86-1.54), or the other secondary outcomes. In the sensitivity analysis, in the full cohort (without propensity-score matching), we found neither a difference in sICH risk (aOR 1.48, 95% CI 0.99-2.20) nor a difference in functional outcome (acOR 0.92, 95% CI 0.76-1.10; Figure 2) between groups.…”

“…The formation of microthrombi might be promoted by vessel wall damage caused by EVT. 2 , 3 Use of antiplatelet drugs could potentially reduce periprocedural formation of microthrombi by inhibiting platelet aggregation and inflammation of the vessel wall, which could ultimately improve microvascular reperfusion. 3 On the other hand, one randomized trial showed that antiplatelet therapy increases the risk of symptomatic intracranial hemorrhage (sICH) when administered early—within 90 min—after intravenous treatment with alteplase.…”

“… 2 , 3 Use of antiplatelet drugs could potentially reduce periprocedural formation of microthrombi by inhibiting platelet aggregation and inflammation of the vessel wall, which could ultimately improve microvascular reperfusion. 3 On the other hand, one randomized trial showed that antiplatelet therapy increases the risk of symptomatic intracranial hemorrhage (sICH) when administered early—within 90 min—after intravenous treatment with alteplase. 4 However, this trial did not focus on the subpopulation of patients with ischemic stroke caused by a large vessel occlusion undergoing EVT.…”

eG Coated Stents Exhibit Enhanced Endothelial Wound Healing Characteristics

“…Stent deployment induces significant injury to the vascular wall at the site of implantation including denudation of the vascular endothelium. 7,12 Considering the role that normal, functioning endothelial cells (ECs) play in regulating smooth muscle cell (SMC) proliferation and in preventing thrombus formation, stent-induced endothelial damage is thought to be a significant contributor to stent-related complications. Thus, rapid endothelial wound healing is considered to be a critical factor in the success of a stenting procedure.…”

Effect of Endothelial Progenitor Cells Transplantation on Neointimal Hyperplasia and Reendothelialization after Balloon Catheter Injury in Rat Carotid Arteries

“…Evans blue could penetrate the areas where the endothelium is permeable and stain the injured surface blue. An intact endothelium could maintain an unstained surface[15]. The injured endothelium labeled by Evans blue could be observed in the 611 nm channel under a light-sheet microscopy.…”