Effects of the different-sized external stents on vein graft intimal hyperplasia and inflammation

Qi Yang; Dong Lei; Shixing Huang; Yi Yang; Yang Yang; Xiaofeng Ye; Zhengwei You; Qiang Zhao

doi:10.21037/atm.2020.01.16

Effects of the different-sized external stents on vein graft intimal hyperplasia and inflammation

Ann Transl Med. 2020 Feb;8(4):102. doi: 10.21037/atm.2020.01.16.

Authors

Qi Yang¹, Dong Lei², Shixing Huang¹, Yi Yang¹, Yang Yang³, Xiaofeng Ye¹, Zhengwei You², Qiang Zhao¹

Affiliations

¹ Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
² State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Belt and Road Joint Laboratory of Advanced Fiber and Low-dimension Materials (Donghua University), College of Materials Science and Engineering, Donghua University, Shanghai 201620, China.
³ Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.

Abstract

Background: The poor long-term patency ratio of vein grafts prevents patients from benefiting from coronary artery bypass graft (CABG). It is reported that external venous stents have notably improved the patency ratio of stented vein grafts in animal models. The most crucial influence on stented grafts' fate is the size of the stents. This study aims to investigate the effects on intimal hyperplasia and inflammation of vein graft by using different sizes of stents and explore the potential mechanism.

Methods: Two different sizes of external stents were fabricated through 3D printing technology. Male SD rats were divided into three groups. In the control group rat's autologous left jugular vein was grafted on the ipsilateral artery directly. In the stent groups, grafts were surrounded by two different-sized stents before anastomosing with arteries. The patency ratio and diameter of the grafts were examined by ultrasound. Masson staining was used to characterize intimal hyperplasia. The expression of inflammatory factors was detected by immunohistochemical staining. Moreover, TUNEL staining was used to label apoptotic cells.

Results: The two sizes of external stents were fabricated by 3D printing technology. In the control group, the intima area and wall thickness dramatically increased 8 weeks after implantation. While in the stent groups, these data only slightly increased, especially in the 1.5 mm-stent group. The expressions of inflammatory factors in TNF signaling were more remarkable than in the control group. On the contrary, the expressions were rarely detected in the stent groups. Similarly, the number of TUNEL positive cells dramatically decreased by using the appropriate-sized stent.

Conclusions: In this study, we concluded that the appropriate sizes of external stents could effectively inhibit vein graft neointima formation, attenuate inflammatory reaction and reduce cell apoptosis, which might improve the long-term patency ratio of vein grafts.

Keywords: Coronary artery bypass graft (CABG); external stent; intimal hyperplasia; saphenous vein graft.