Vascular Injury After Stenting - Insights of Systemic Mechanisms of Vascular Repair -

Background: The role of circulating progenitor cells (CPC) in vascular repair following everolimus-eluting stent (EES) implantation is largely unknown. The aim of the study was to investigate the relationship between temporal variation in CPC levels following EES implantation and the degree of peri-procedural vascular damage, and stent healing, as measured by optical coherence tomography (OCT). Methods and Results: CPC populations (CD133+/KDR+/CD45low) included patients with stable coronary artery disease undergoing stent implantation, and were evaluated using a flow cytometry technique both at baseline and at 1 week. OCT evaluation was performed immediately post-implantation to quantify the stent-related injury and at a 9-month follow up to assess the mid-term vascular response. Twenty patients (mean age 66 +/- 9 years; 80% male) with EES-treated stenoses (n=24) were included in this study. Vascular injury score was associated with the 1-week increase of CD133+/KDR+/CD45low (beta 0.28 [95% CI 0.15; 0.41]; P<0.001) and with maximum neointimal thickness at a 9-month follow up (beta 0.008 [95% CI 0.0004; 0.002]; P=0.04). Inverse relationships between numbers of uncoated and apposed struts for the 9-month and the 1-week delta values of CD133+/KDR+/CD45low (beta -12.53 [95% CI -22.17; -2.90]; P=0.011), were also found. Conclusions: The extent of vessel wall injury influences early changes in the levels of CPC and had an effect on mid-term vascular healing after EES implantation. Early CPC mobilisation was associated with mid-term strut coverage.

Automated summary

This study aimed to investigate the relationship between circulating progenitor cells (CPC) levels and peri-procedural vascular damage, as well as stent healing, following everolimus-eluting stent (EES) implantation. The study found that an increase in CD133+/KDR+/CD45low levels one week after EES implantation was associated with vascular injury score, and the maximum neointimal thickness at a 9-month follow up. In addition, there was an inverse relationship between the changes in CPC levels and the number of uncoated and apposed struts at the 9-month follow up and one week. These findings suggest that the extent of vessel wall injury impacts early changes in CPC levels and has an effect on mid-term vascular healing after EES implantation.