Zusammenfassung
Obwohl die Entwicklung biodegradierbarer Polymerstents in den letzten Jahren große Fortschritte gemacht hat, verbleiben entscheidende noch zu lösende Probleme bestehen. Veränderungen im Design und in der chemischen Zusammensetzung sollen die Eigenschaften biodegradierbarer Stents optimieren und ihre Schwächen beseitigen.
Der neue PLLA/P4HB-Stent konnte erfolgreich endovaskulär in die A. carotis communis von 10 Landschweinen implantiert werden, bei vergleichbaren mechanischen Eigenschaften zu 316L-Metallstents als Kontrollgruppe. 4 Wochen nach Implantation erfolgte eine Angio-CT zur Stenosegradbestimmung. Es zeigten sich deutlich höhere Stenosegrade in der PLLA/P4HB-Stent-Gruppe (52,05 ± 5,80 %) gegenüber der Metall-Stent-Gruppe (35,65 ± 3,72 %). Durch die orale Gabe von Atorvastatin konnte der distale Stenosegrad nach NASCET in der PLLA/P4HB-Stent-Gruppe (39,81 ± 8,57 %) auf das Niveau der Metall-Stent-Gruppe (44,21 % ± 2,34) gesenkt werden.
Der PLLA/P4HB-Stent stellt einen vielversprechenden Ansatz zur Lösung der bestehenden Probleme beim Einsatz permanenter Stents dar. Nur wenn sich ein Stent vollständig auflöst, ist eine Heilung im Sinne einer Restitutio ad integrum möglich.
Abstract
Over the past years the development of biodegradable polymeric stents has made great progress; nevertheless, essential problems must still be solved. Modifications in design and chemical composition should optimize the quality of biodegradable stents and remove the weaknesses. New biodegradable poly-L-lactide/poly-4-hydroxybutyrate (PLLA/P4HB) stents and permanent 316L stents were implanted endovascularly into both common carotid arteries of 10 domestic pigs. 4 weeks after implantation computed tomography (CT) angiography was carried out to identify the distal degree of stenosis. The PLLA/P4HB group showed a considerably lower distal degree of stenosis by additional oral application of atorvastatin (mean 39.81 ± 8.57 %) compared to the untreated PLLA/P4HB group without atorvastatin (mean 52.05 ± 5.80 %). The 316L stents showed no differences in the distal degree of stenosis between the group treated with atorvastatin (mean 44.21 ± 2.34 %) and the untreated group (mean 35.65 ± 3.72 %).
Biodegradable PLLA/P4HB stents generally showed a promising approach for the solution of the existing problems of permanent stents. Restitutio ad integrum is only achievable if a stent is completely degraded.
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Interessenkonflikt. S. Kischkel, N. Grabow, A. Püschel, B. Erdle, M. Kabelitz, D.P. Martin, S.F. Williams, I. Bombor, K. Sternberg, K.-P. Schmitz, W. Schareck und C.M. Bünger geben an, dass kein Interessenkonflikt besteht.
Die korrespondierende Autorin bestätigt, dass alle nationalen Richtlinien zur Haltung und zum Umgang mit Labortieren eingehalten wurden und die notwenigen Zustimmungen der zuständigen Behörden vorliegen.
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Kischkel, S., Grabow, N., Püschel, A. et al. Biodegradierbare Polymerstents für die vaskuläre Applikation im Karotis-Modell beim Schwein. Gefässchirurgie 19, 358–363 (2014). https://doi.org/10.1007/s00772-014-1311-4
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DOI: https://doi.org/10.1007/s00772-014-1311-4