Release of Intracoronary Microparticles during Stent Implantation into Stable Atherosclerotic Lesions under Protection with an Aspiration Device

Patrick Horn, Theodor Baars, Philipp Kahlert, Christian Heiss, Ralf Westenfeld, Malte Kelm, Raimund Erbel, Gerd Heusch, Petra Kleinbongard, Patrick Horn, Theodor Baars, Philipp Kahlert, Christian Heiss, Ralf Westenfeld, Malte Kelm, Raimund Erbel, Gerd Heusch, Petra Kleinbongard

Abstract

Objective: Stent implantation into atherosclerotic coronary vessels impacts on downstream microvascular function and induces the release of particulate debris and soluble substances, which differs qualitatively and quantitatively between native right coronary arteries (RCAs) and saphenous vein grafts on right coronary arteries (SVG-RCAs). We have now quantified the release of microparticles (MPs) during stent implantation into stable atherosclerotic lesions and compared the release between RCAs and SVG-RCAs.

Methods: In symptomatic, male patients with stable angina and a stenosis in their RCA or SVG-RCA, respectively (n = 14/14), plaque volume and composition were analyzed using intravascular ultrasound before stent implantation. Coronary aspirate was retrieved during stent implantation with a distal occlusion/aspiration device and divided into particulate debris and plasma. Particulate debris was weighed. Platelet-derived MPs (PMPs) were distinguished by flow cytometry as CD41+, endothelium-derived MPs (EMPs) as CD144+, CD62E+ and CD31+/CD41-, leukocyte-derived MPs as CD45+, and erythrocyte-derived MPs as CD235+.

Results: In patients with comparable plaque volume and composition in RCAs and SVG-RCAs, intracoronary PMPs and EMPs were increased after stent implantation into their RCAs and SVG-RCAs (CD41+: 2729.6 ± 645.6 vs. 4208.7 ± 679.4 and 2355.9 ± 503.9 vs. 3285.8 ± 733.2 nr/µL; CD144+: 451.5 ± 87.9 vs. 861.7 ± 147.0 and 444.6 ± 74.8 vs. 726.5 ± 136.4 nr/µL; CD62E+: 1404.1 ± 247.7 vs. 1844.3 ± 378.6 and 1084.6 ± 211.0 vs. 1783.8 ± 384.3 nr/µL, P < 0.05), but not different between RCAs and SVG-RCAs.

Conclusion: Stenting in stable atherosclerotic lesions is associated with a substantial release not only of PMPs, but also of EMPs in RCAs and SVG-RCAs. Their release does not differ between RCAs and SVG-RCAs.

Trial registration: ClinicalTrials.gov NCT01430884.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. RCA and SVG-RCA plaque volume…
Fig 1. RCA and SVG-RCA plaque volume (A) and composition (B) by IVUS VH analysis.
Data are mean±SEM, comparison by unpaired t-test. RCA = native right coronary arteries, SVG-RCA = saphenous vein grafts on right coronary arteries.
Fig 2. Plasma concentration of TF, and…
Fig 2. Plasma concentration of TF, and number of TF-bearing MPs in RCA and SVG-RCA before and after stent implantation.
Data are presented as minimum and maximum (crosses), interquartile range from 25 to 75% (box), mean (square), and median (line) in a box plot. Comparison between arterial plasma and aspirate plasma as well as RCA and SVG-RCA was done by 2-way repeated measures ANOVA followed by Fishers LSD post-hoc test; MPs = microparticles, nr = number, RCA = native right coronary arteries, SVG-RCA = saphenous vein grafts on right coronary arteries, TF = tissue factor.
Fig 3. Numbers of MPs in RCA…
Fig 3. Numbers of MPs in RCA and SVG-RCA before and after stent implantation.
Numbers of PMPs (CD41+), EMPs (CD144+, CD62E+ or CD31+/CD41-), LMPs (CD45+), and ERMPs (CD235+) are presented as minimum and maximum (crosses), interquartile range from 25 to 75% (box), mean (square), and median (line) in a box plot. Comparison between arterial plasma and aspirate plasma as well as RCA and SVG-RCA was done by 2-way repeated measures ANOVA followed by Fishers LSD post-hoc test; EMPs = endothelium-derived MPs, ERMPs = erythrocyte-derived MPs, LMPs = leukocyte-derived MPs, MPs = microparticles, nr = number, PMPs = platelet-derived MPs, RCA = native right coronary arteries, SVG-RCA = saphenous vein grafts on right coronary arteries.

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