Die Restenose stellt ein zentrales Problem der interventionellen Kardiologie dar und ist häufigste Komplikation nach perkutanen Angioplastieverfahren. Hauptursache dieser Wiederverengung des Gefäßes ist die Bildung einer Neointima durch die Proliferation transdifferenzierter vaskulärer glatter Muskelzellen und die Sekretion extrazellulärer Matrix. Die Entstehung reaktiver Sauerstoffspezies (ROS) und die Entzündungsreaktion nach der Gefäßverletzung werden als frühe, die Neointimabildung induzierende Prozesse diskutiert. Im Rahmen dieser Arbeit wurden mehrere Projekte bearbeitet, die Aufschluss über die während der Neointimabildung statt findenden Prozesse geben sollen. Mit Hilfe eines Verletzungsmodells der murinen Femoralarterie wurde der Einfluss der Entzündung und der ROS-Bildung auf die Neointimabildung in der Maus untersucht. Die Behandlung mit dem mitochondrialen Superoxiddismutase-Mimetikum MitoTEMPO verminderte die Bildung der Neointima besser, als die Behandlung mit dem globalen ROS-Fänger N-Acetylcystein. Die stärkste Hemmung der Neointimabildung wurde jedoch durch die Immunsuppression mit Rapamycin erreicht. Interferon-γ (INFγ) ist ein wichtiges Zytokin der Th1-Immunantwort, das in Folge der Gefäßverletzung freigesetzt wird und die proinflammatorischen Chemokine CXCL9 (MIG, Monokine Induced by INF), CXCL10 (IP-10, INF inducible Protein of 10 kDa) und CXCL11 (I-TAC, Interferon inducible T cell-Chemoattractant) induziert. CXCL9, CXCL10 und CXCL11 sind Liganden des CXC-Chemokinrezeptors 3 (CXCR3) und locken chemotaktisch CXCR3 positive Entzündungszellen zum Ort der Gefäßverletzung. Daher wurde die spezielle Bedeutung des Chemokins CXCL10 in der Restenose untersucht. Dazu wurden CXCL10-defiziente Mäuse dem Femoralisverletzungsmodell unterzogen und die Gefäße nach 14 Tagen morphometrisch und immunhistologisch untersucht. CXCL10-Defizienz führte in Mäusen zu einer verminderten Neointimabildung, die mit einer verringerten Inflammation, Apoptose und Proliferation im verletzten Gefäß korrelierte. Neben der Inflammation beeinflusst aber auch die Reendothelialisierung der verletzten Gefäßwand die Restenose. Interessanterweise war im Vergleich zu Wildtyp-Mäusen in den CXCL10-Knockout-Mäusen auch die Reendothelialisierung erheblich verbessert. Offensichtlich ist das CXCR3-Chemokinsystem also in völlig unterschiedliche biologische Prozesse involviert und beeinflusst nicht nur die Bildung der Neoimtima durch die Förderung der Entzündung, sondern auch die Unterdrückung der Reendothelialisierung der verletzten Gefäßwand. Tatsächlich wird der CXCR3 nicht nur auf Entzündungszellen, sondern auch auf Endothelzellen exprimiert. Zur separaten Untersuchung der Rolle des CXCR3 in der Inflammation und der Reendothelialisierung wurde im Rahmen dieser Arbeit damit begonnen konditionelle CXCR3-Knockout-Mäuse zu generieren, in denen der CXCR3 entweder in Entzündungszellen oder in Endothelzellen ausgeschaltet ist. Zum besseren Verständnis der molekularen Mechanismen, mit denen der CXCR3 seine Funktionen vermittelt, wurde zudem untersucht ob dieser mit anderen G-Protein-gekoppelten Rezeptoren (GPCR) interagiert. Die Analyse von Coimmunpräzipitaten deutet auf eine Homodimerisierung der beiden CXCR3 Splicevarianten CXCR3A und CXCR3B, sowie auf die Heterodimerbildung von CXCR3A und CXCR3B mit sich, sowie jeweils mit CCR2, CCR3, CCR5 und den Opioidrezeptoren MOR und KOR hin. Die getestete Methode des Fluoreszenz-Resonanz-Energietransfers (FRET) erwies sich jedoch als ungeeignet zur Untersuchung von CXCR3, da dieser in HEK293T-Zellen nicht korrekt transient exprimiert wurde. Insgesamt deuten die Ergebnisse dieser Arbeit darauf hin, dass das CXCR3-Chemokinsystem eine zentrale Rolle in unterschiedlichen, die Neointimabildung beeinflussenden Prozessen spielt. Damit könnten der CXCR3 und insbesondere das Chemokin CXCL10 interessante Zielmoleküle in der Entwicklung neuer verbesserter Therapien zur Verhinderung der Restenose darstellen. / Restenosis represents a central problem after coronary angioplasty procedures and is caused by intimal hyperplasia, also called neointima, as a result of transdifferentiation, proliferation of vascular smooth muscle cells and secretion of extracellular matrix. Formation of reactive oxygen species (ROS) and inflammation after vascular injury caused by angioplasty are discussed as early inducers of neointima formation. In several projects the processes causing the development of intimal hyperplasia were investigated. First of all, the impact of inflammation and ROS in neointima formation was investigated using the mouse femoral injury model. The mitochondrial superoxide dismutase mimetic mitoTEMPO could reduce neointima formation better than the global ROS scavenger N-acetylcystein. However, the strongest reduction of neointima formation was achieved by the treatment with the immunosuppressant rapamycin. Interferon-γ(INFγ) is a major cytokine of the Th1 immune response. It is released as a result of vessel injury and induces the proinflammatory chemokines CXCL9 (MIG, Monokine Induced by INF), CXCL10 (IP-10, INF inducible Protein of 10 kDa) and CXCL11 (I-TAC, Interferon inducible T-cell-Chemoattractant), which are ligands of the CXC chemokine receptor 3 (CXCR3) and by this chemotactically recruit CXCR3 positive cells to the site of vessel injury. In this work the special role of CXCL10 in restenosis was investigated. Therefore, CXCL10 decient mice underwent the mouse femoral injury model. The vessels were analysed morphometrically and immunohistologically 14 days after injury. CXCL10 deciency lead to decreased neointima formation that correlated with a reduced recruitment of inflammatory cells as well as diminished numbers of apoptotic and proliferating cells at the site of vessel injury. In addition to inflammation the reconstitution of the endothelium has also impact on the development of restenosis. Interestingly reendothelialisation was strongly improved in CXCL10 decient mice compared to wildtype mice. Obviously the CXCR3 chemokine system is involved in different biological prosesses and impairs neointima formation on one hand by the advancement of inflammation and on the other hand by the suppression of reendothelialisation. In fact the CXCR3 is not only expressed on inflammatory cells but also on endothelial cells. To investigate the role of CXCR3 in inflammation and reendothelialisation separatly the generation of conditional CXCR3 knockout mice with a CXCR3 knockout in T-cells or endothelial cells was started in an additional project. For a better understanding of the molecular mechanisms on which the CXCR3 mediates its biological functions the protein-protein interactions of the CXCR3 with other G-protein coupled recteptors (GPCR) was analysed. Coimmunoprecipitation showed homodimerization of the CXCR3 splice variants CXCR3A and CXCR3B, as well as heterodimerization of CXCR3A and CXCR3B with each other and with the chemokine receptors CXCR4, CCR2, CCR3, CCR5 and the opioid receptors MOR and KOR. The additional tested Fluorecence resonance energy transfer (FRET) method proved to be not suitable to measure interactions of CXCR3, since this receptor could not be expressed correctly on the cell surface after transient transfection. To summarise, the results indicate that the CXCR3 chemokine system plays a central role in different processes that mediate neointima formation. Thus, the CXCR3 and especially the chemokine CXCL10 could be interesting therapeutic targets in the development of new or improved treatments to reduce the risk of restenosis.

Hypertension is a risk factor for many cardiovascular and cerebrovascular diseases such as atherosclerosis and stroke. It is therefore important to understand the effect of hypertension on temporal growth and remodeling of arteries. In this study, experimental hypertension was induced in the mini-pig by aortic coarctation. Basilar arteries and aortas were collected for analysis over an eight week period of hypertension with specimens from normotensive animals serving as controls. Changes in mechanical properties of the basilar artery were evaluated by in vitro pressure-diameter tests on intact cylindrical segments at their in situ length. The basilar arteries from hypertensive animals became less distensible, reflecting increases in both structural and material stiffness, compared to their normotensive counterparts. The circumferential stress rapidly returned toward its homeostatic value by increasing the wall thickness within two weeks. Immunohistochemistry, which is capable of illustrating the localization and distribution of protein expression, was performed to examine changes in wall constituents in the aorta. The increased medial thickness observed in hypertensive pigs compared to normotensive pigs was due to hyperplasia of smooth muscle cells (SMCs) and accumulation of extracellular matrix proteins, which were accompanied by the phenotypic modulation of SMCs. The increased interlamellar thickness, collagen fibers, and the thickness of elastic lamina found in the inner media of hypertensive animal may be associated with the gradient of stress decreasing into the outer media. SMC proliferation, if any, was found evenly distributed across the media, however. In cases showing increased proliferation and matrix protein synthesis, the SMC contractile markers were down-regulated whereas the SMC synthetic markers were up-regulated. While the aortic intima appeared normal in the normotensive animals, neointima formation, which may predispose the vessel to atheroma formation, was found in the hypertensive animals. Immunohistochemistry of Hsp47 and procollagen revealed that the endothelial cells (ECs) may produce collagen, specifically type I collagen in response to hypertension and contribute to the thickened intima. In addition, lectin staining for ECs markers and immunostaining for eNOS suggested that endothelial cells may transdifferentiate into intimal SMCs. These findings suggested an alternative role that ECs may play in hypertension-induced atherogenesis.

Monocyte recruitment promotes the accumulation of myeloid foam cells in early atherosclerotic plaques. However, initial foam cells form prior to increased monocyte recruitment in hypercholesterolemic Ldlr-/- mice. These initial foam cells are derived from myeloid cells residing in the normal intima, and express integrin alphaX (CD11c). The goal of this thesis was to assess the role of initial foam cells in atherogenesis. The approach was to delete these cells by diphtheria toxin-induced apoptosis in Ldlr-/- bone marrow chimeras. Depletion of CD11c+ leukocytes resulted in significant reductions of intimal lipid accumulation, monocyte recruitment, intimal chemokine expression, but not endothelial cell adhesion molecule expression, at 10 and 21 days of hypercholesterolemia. These data suggest that lipid uptake by resident intimal CD11c-expressing myeloid cells during the earliest stages of atherosclerosis promotes chemokine production that is required for increased monocyte recruitment.

Monocyte recruitment promotes the accumulation of myeloid foam cells in early atherosclerotic plaques. However, initial foam cells form prior to increased monocyte recruitment in hypercholesterolemic Ldlr-/- mice. These initial foam cells are derived from myeloid cells residing in the normal intima, and express integrin alphaX (CD11c). The goal of this thesis was to assess the role of initial foam cells in atherogenesis. The approach was to delete these cells by diphtheria toxin-induced apoptosis in Ldlr-/- bone marrow chimeras. Depletion of CD11c+ leukocytes resulted in significant reductions of intimal lipid accumulation, monocyte recruitment, intimal chemokine expression, but not endothelial cell adhesion molecule expression, at 10 and 21 days of hypercholesterolemia. These data suggest that lipid uptake by resident intimal CD11c-expressing myeloid cells during the earliest stages of atherosclerosis promotes chemokine production that is required for increased monocyte recruitment.

Atherosclerosis, the leading cause of mortality in Western societies, affects large elastic arteries, causing focal deposition of proliferative inflammatory and lipid-laden cells within the artery. Several risk factors have been causally implicated in the ???reaction to injury??? hypothesis first described by Ross in 1969. The ???injury??? sustained by endothelial cells may be either mechanical or chemical. Environmental factors have a role in the production of chemical agents that are injurious to the endothelium. Mechanical stresses such as wall tensile stress are proportional to systemic blood pressure and pulse pressure. Essentially, these systemic pressures are fairly evenly distributed throughout the circulation. However, atherosclerotic lesions characteristically occur at focal sites within the human vasculature; at or near bifurcations, within the ostia of branch arteries and at regions of marked or complex curvature, where local haemodynamic abnormalities occur. The most discussed haemodynamic factor seems to be low or highly oscillating wall shear stress which exists on the outer wall of bifurcations and on the inner aspect of curving vessels. The magnitude of these haemodynamic forces may not be great but the subtleties of their variable spatial distribution may help to explain the multifocal distribution of atherosclerotic plaques. With the altered haemodynamics there is endothelial injury and phenotypic changes in the endothelium result, which in turn lead to endothelial cell dysfunction. These haemodynamic variables are difficult to measure directly in vivo. In this work a novel model is developed utilising human autologous vein bypass grafts as a surrogate vessel for the observation of pathological structural changes in response to altered haemodynamics. The influence of haemodynamic factors (such as wall shear stress) in the remodeling of the vein graft wall and the pathogenesis of Myointimal Hyperplasia (MIH) and resultant wall thickening in femoral bypass grafts is analysed. The haemodynamic determinants of MIH (which have been established in many animal models) are similar to those implicated in atherosclerosis. The accelerated responses of the vein (Intimal hyperplasia develops much more rapidly than atherosclerotic lesions in native vessels) make it an ideal model to expediently examine the hypothesised relationships prospectively in an in vivo setting. Furthermore, the utilisation of in vivo data acquired from non-invasive diagnostic methods (such as Magnetic Resonance Angiography (MRA) and Duplex ultrasound) combined with the application of state-of-the-art Computational Fluid Dynamic (CFD) techniques makes the model essentially non-invasive. The following hypotheses are examined: 1) regions of Low shear and High tensile stress should develop disproportionately greater wall thickening, 2) regions of greater oscillatory blood flow should develop greater wall thickening, and 3) regions of lower wall shear should undergo inward (or negative) remodelling and result in a reduction in vessel calibre. The conclusions reached are that abnormal haemodynamic forces, namely low Time-averaged Wall Shear Stress, are associated with subsequent wall thickening. These positive findings have great relevance to the understanding of vein graft MIH and atherosclerosis. It was also evident that with non-invasive data and CFD techniques, some of the important haemodynamic factors are realistically quantifiable (albeit indirectly). The detection of parameters known to be causal in the development of graft intimal hyperplasia or other vascular pathology may improve ability to predict clinical problems. From a surgical perspective this might be employed to facilitate selection of at-risk grafts for more focused postoperative surveillance and reintervention. On a broader stage the utilisation of such analyses may be useful in predicting individuals at greater risk of developing atherosclerotic deposits, disease progression, and the likelihood of clinical events such as heart attack, stroke and threat of limb loss.

OBJETIVO: analisar, por meio de morfometria digital, a reação intimal presente na artéria carótida de suínos submetidos à angioplastia isoladamente e à angioplastia seguida de implante de stent de cromo - cobalto. MATERIAIS E MÉTODOS: em oito suínos sadios foi realizada a angioplastia isolada da artéria carótida comum (ACC) direita e angioplastia com implante de um stent de cromo – cobalto expansível por balão na artéria carótida comum esquerda. Após período de quatro semanas, os animais foram submetidos à eutanásia para a retirada de amostras de tecido arterial e preparo de lâminas histológicas divididas do seguinte modo: grupo 1, segmento médio da artéria carótida comum direita (angioplastia isolada); grupo 2, segmento médio da artéria carótida comum esquerda em localização “intra stent”. As imagens das lâminas foram digitalizadas e analisadas por programa de morfometria digital com cálculo da área luminal, área da camada íntima e área da camada média dos cortes histológicos. A análise estatística foi realizada através da média e desvio padrão das áreas em cada grupo, utilizando-se Teste t de Student. O valor de p<0,05 foi considerado significativo. RESULTADOS: na análise das médias das áreas obtidas, foi encontrada maior hiperplasia em resposta ao implante de stent e diferença estatisticamente significativa quando realizada a comparação entre a área do lúmen (5,841 x 106μm2 X 1,287 x 106μm2), da lâmina elástica interna (6,566 x 106μm2 X 1,287 x 106μm2) e lâmina elástica externa (9,832 x 106μm2 X 4,559 x 106μm2) dos dois grupos (ATP + STENT X ATP; medidas em micrômetros quadrados). Não se observou diferença significativa do ponto de vista estatístico quando se realizou a comparação entre as camadas médias dos dois grupos (3,266 x 106μm2 X 3,271 x 106μm2). CONCLUSÃO: o implante de stent de cromo-cobalto expansível por balão na ACC do suíno gerou um espessamento intimal maior do que aquele produzido apenas pela angioplastia, porém este não foi suficiente para afetar o lúmen arterial. / OBJECTIVE: to analyze, through digital morphometry, the intimal reaction in the carotid artery of pigs submitted to isolated angioplasty and angioplasty followed by implantation of cobalt-chromium stent. MATERIALS AND METHODS: eight healthy pigs had their common carotid artery (CCA) submitted to isolated angioplasty in the right side and angioplasty plus stenting in the left side. Four weeks latter, all animals were submitted to euthanasia for arterial tissue sampling and preparation of histological blades sorted as follows: group 1, middle segment of common right carotid artery (isolated angioplasty); group 2, middle segment of common left carotid artery (intra-stent). Blade images were scanned and analyzed through a digital morphometry program with calculation of luminal, intimal and media layers area in the histological sections. The statistical analysis was performed through mean values and standard deviations of the areas in each group, using the Student’s t-Test. The value of p<0.05 was considered significant. RESULTS: When compare to angioplasty alone, the stent group showed greater hyperplasia in response to implantation regarding the lumen area (5.841 x 106μm2 X 1.287 x 106μm2), the internal elastic lamina area (6.566 x 106μm2 X 1.287 x 106μm2) and the external elastic lamina area (9.832 x 106μm2 X 4.559 x 106μm2). No statistically significant difference was observed when comparing the media layers of both groups (3.266 x 106μm2 X 3.271 x 106μm2). CONCLUSION: angioplasty followed by the implantation of a cobalt-chromium balloon expandable stent in the CCA of the pig creates more intimal thickening than angioplasty alone. Nevertheless intimal thickening was not enough to affect the luminal area thanks to a positive elastic remodeling effect.

Orientador: Luis Gustavo Modelli de Andrade / Resumo: Introdução: O transplante renal é a melhor opção de tratamento para doença renal crônica estadio V. Melhora substancial da sobrevida do enxerto no primeiro ano ocorreu principalmente pela drástica redução dos índices de rejeição aguda com o uso de imunossupressores potentes, destacando-se os inibidores de calcineurina. Porém essa não se acompanhou de melhora da sobrevida do paciente e do enxerto em longo prazo. A mortalidade cardiovascular continua sendo a principal causa de morte no transplante renal. A hipertrofia do ventrículo esquerdo (HVE) e a aterosclerose são muito prevalentes nessa população e constituem fatores de risco para eventos cardiovasculares. Os inibidores da mTOR (mammalian target of rapamycin inhibitor) parecem ser drogas promissoras na redução da HVE e na redução e prevenção de aterosclerose no campo experimental, porém seu efeito nos pacientes transplantados renais ainda é controverso.Objetivo: Comparar a ação do everolimo com o tacrolimo na redução do índice de massa do ventrículo esquerdo (iMVE) e da espessura médio intimal das carótidas (EMIC) em pacientes transplantados renais.Material e Métodos: Ensaio clínico prospectivo, randomizado, unicêntrico, cego para o cardiologista que realizou os ecocardiogramas. Os pacientes receberam imunossupressão inicial com Tacrolimo (Tac), Micofenolato sódico (MFS) e Presnisona (PDN). Após 12±4 semanas, pacientes que preencheram critérios de inclusão e exclusão foram randomizados 1:1 nos grupos: TACRO (controle) ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Kidney transplantation is the gold standard treatment for end-stage renal disease. Allograft survival after one year of transplantation has had a significant improvement. However, there is a lack of improvement in patient and allograft long term survival. The mTOR inhibitors (mammalian target of rapamycin inhibitor) are the newest drugs available to prevent allograft rejection and they seem to have potential benefits in reducing myocardial hypertrophy and atherosclerosis in experimental studies. This benefits for kidney transplanted patients is still controversial. Objective: To compare the effect of everolimus to the tacrolimus in reducing left ventricular mass index (LVMi) and carotid intima-media thickness (IMT) after one year in kidney transplanted patients. Material and Methods: This randomized, open-label, controlled trial compared the effect of everolimus to tacrolimus in reducing the LVMi and the IMT in kidney transplanted patients after one year of these immunosuppressive therapies. After initial immunosuppression with tacrolimus, mycophenolate sodium (MFS) and prednisone (PDN), patients were randomly assigned at 12±4 weeks in a 1:1 ratio to undergo conversion from tacrolimus to everolimus (EVERO group) and maintenance of MFS and PDN or continue on standard tacrolimus-based treatment (TACRO group). Each patient was randomized only after a kidney biopsy with no evidence of rejection or inflammation. Clinical and laboratorial data were collected on random... (Complete abstract click electronic access below) / Doutor

Os stents são dispositivos intravasculares implantados com o objetivo de dilatar ou fixar a placa de colesterol contra a parede arterial. O objetivo avaliar dois tipos de stents de aço inoxidável, um recoberto com poliéster (dacron) e outro não recoberto, implantados na aorta infra-renal de suínos jovens, foram avaliados por morfometria digital para medir o espessamento intimal. Foi realizado um estudo experimental randomizado, separados em dois grupos(stents não revestidos e revestidos com dacron) e duas fases (I e II). Oito stents recobertos com dacron e oito stents de aço inoxidável (30mm de extensão e 8 mm de diâmetro), não revestidos, foram implantados através de abordagem retroperitoneal na aorta infrarenal normal de 16 suínos normolipêmicos. Para a passagem do sistema de implante, foi necessário uma pequena arteriotomia na aorta distal (fase I). Após quatro semanas, a aorta com os stents foram removidas em monoblocos (fase II). Os valores de hematimetria e do lipidograma foram coletados nas duas fases e não apresentaram alterações que pudessem influenciar o estudo. Amostras de tecido dos sítios de fixação (proximal e distal) dos stents foram retiradas, confeccionadas lâminas, que foram coradas pelas técnicas de hematoxilina e eosina de Verhoeff e enviadas para análise morfométrica digital. A camada intima distal não apresentou diferença estatística significativa. A camada média proximal das porções proximal e da porção distal não apresentaram diferença entre os grupos. Os dois tipos de stents apresentaram 100% de perviedade, boa biocompatibilidade e boa incorporação a parede aórtica de suínos normolipêmicos. A camada íntima proximal do grupo de stents revestidos com dacron apresentou espessura maior do que os stents não revestidos, mas com significância estatísitica limítrofe. / Stents are intravascular devices implanted with the objective of dilating or fixing the cholesterol plate against the arterial wall. To evaluate, by digital morphometry, the intimal thickening after the placement of two different kinds of stents: polyester covered stainless steel stents (Dacron) and non-covered stents implanted in young pigs’ infrarenal aortas. The stents were made at the Biotransformation Laboratory of Federal University of Rio Grande do Sul. The experiment was performed at the Biotério of University of Caxias do Sul, carried out on two separate groups of pigs. Eight polyester-covered stainless steel stents (Dacron) and eight stainless steel stents (30-mm long, 8-mm diameter) were deployed through extraperitoneal approach in the normal infrarenal aorta of 16 normolipemic pigs. To allow the passage of the delivery system, a small arteriotomy was performed (phase I). After four weeks, the aorta with the stent was removed en bloc. (phase II). The values of the hematimetric and lipid analysis did not show any changes that could influence the study. Tissue samples of the fixing sites (proximal and distal) of the stents were taken. Microscope slices were prepared and submitted to Verhoeff’s hematoxilin and eosin techniques and sent to morphometric analysis.The intima immediately proximal to the device was thicker in the group of covered stents with marginal significance. The distal intimal layer, proximal medial layer of the proximal portion and distal portion did not present statistical difference between the two groups. Patency was 100% in both groups of these normolipemic pigs. After four weeks the intimal layer immediately proximal to the covered stents was ticker when compared to uncovered stents, but this had a borderline significance. The intimal layer distal to covered stents and the media proximal or distal to the devices had similar morphometric features when covered and uncovered stents where compared.

OBJETIVO: analisar, por meio de morfometria digital, a reação intimal presente na artéria carótida de suínos submetidos à angioplastia isoladamente e à angioplastia seguida de implante de stent de cromo - cobalto. MATERIAIS E MÉTODOS: em oito suínos sadios foi realizada a angioplastia isolada da artéria carótida comum (ACC) direita e angioplastia com implante de um stent de cromo – cobalto expansível por balão na artéria carótida comum esquerda. Após período de quatro semanas, os animais foram submetidos à eutanásia para a retirada de amostras de tecido arterial e preparo de lâminas histológicas divididas do seguinte modo: grupo 1, segmento médio da artéria carótida comum direita (angioplastia isolada); grupo 2, segmento médio da artéria carótida comum esquerda em localização “intra stent”. As imagens das lâminas foram digitalizadas e analisadas por programa de morfometria digital com cálculo da área luminal, área da camada íntima e área da camada média dos cortes histológicos. A análise estatística foi realizada através da média e desvio padrão das áreas em cada grupo, utilizando-se Teste t de Student. O valor de p<0,05 foi considerado significativo. RESULTADOS: na análise das médias das áreas obtidas, foi encontrada maior hiperplasia em resposta ao implante de stent e diferença estatisticamente significativa quando realizada a comparação entre a área do lúmen (5,841 x 106μm2 X 1,287 x 106μm2), da lâmina elástica interna (6,566 x 106μm2 X 1,287 x 106μm2) e lâmina elástica externa (9,832 x 106μm2 X 4,559 x 106μm2) dos dois grupos (ATP + STENT X ATP; medidas em micrômetros quadrados). Não se observou diferença significativa do ponto de vista estatístico quando se realizou a comparação entre as camadas médias dos dois grupos (3,266 x 106μm2 X 3,271 x 106μm2). CONCLUSÃO: o implante de stent de cromo-cobalto expansível por balão na ACC do suíno gerou um espessamento intimal maior do que aquele produzido apenas pela angioplastia, porém este não foi suficiente para afetar o lúmen arterial. / OBJECTIVE: to analyze, through digital morphometry, the intimal reaction in the carotid artery of pigs submitted to isolated angioplasty and angioplasty followed by implantation of cobalt-chromium stent. MATERIALS AND METHODS: eight healthy pigs had their common carotid artery (CCA) submitted to isolated angioplasty in the right side and angioplasty plus stenting in the left side. Four weeks latter, all animals were submitted to euthanasia for arterial tissue sampling and preparation of histological blades sorted as follows: group 1, middle segment of common right carotid artery (isolated angioplasty); group 2, middle segment of common left carotid artery (intra-stent). Blade images were scanned and analyzed through a digital morphometry program with calculation of luminal, intimal and media layers area in the histological sections. The statistical analysis was performed through mean values and standard deviations of the areas in each group, using the Student’s t-Test. The value of p<0.05 was considered significant. RESULTS: When compare to angioplasty alone, the stent group showed greater hyperplasia in response to implantation regarding the lumen area (5.841 x 106μm2 X 1.287 x 106μm2), the internal elastic lamina area (6.566 x 106μm2 X 1.287 x 106μm2) and the external elastic lamina area (9.832 x 106μm2 X 4.559 x 106μm2). No statistically significant difference was observed when comparing the media layers of both groups (3.266 x 106μm2 X 3.271 x 106μm2). CONCLUSION: angioplasty followed by the implantation of a cobalt-chromium balloon expandable stent in the CCA of the pig creates more intimal thickening than angioplasty alone. Nevertheless intimal thickening was not enough to affect the luminal area thanks to a positive elastic remodeling effect.

Os stents são dispositivos intravasculares implantados com o objetivo de dilatar ou fixar a placa de colesterol contra a parede arterial. O objetivo avaliar dois tipos de stents de aço inoxidável, um recoberto com poliéster (dacron) e outro não recoberto, implantados na aorta infra-renal de suínos jovens, foram avaliados por morfometria digital para medir o espessamento intimal. Foi realizado um estudo experimental randomizado, separados em dois grupos(stents não revestidos e revestidos com dacron) e duas fases (I e II). Oito stents recobertos com dacron e oito stents de aço inoxidável (30mm de extensão e 8 mm de diâmetro), não revestidos, foram implantados através de abordagem retroperitoneal na aorta infrarenal normal de 16 suínos normolipêmicos. Para a passagem do sistema de implante, foi necessário uma pequena arteriotomia na aorta distal (fase I). Após quatro semanas, a aorta com os stents foram removidas em monoblocos (fase II). Os valores de hematimetria e do lipidograma foram coletados nas duas fases e não apresentaram alterações que pudessem influenciar o estudo. Amostras de tecido dos sítios de fixação (proximal e distal) dos stents foram retiradas, confeccionadas lâminas, que foram coradas pelas técnicas de hematoxilina e eosina de Verhoeff e enviadas para análise morfométrica digital. A camada intima distal não apresentou diferença estatística significativa. A camada média proximal das porções proximal e da porção distal não apresentaram diferença entre os grupos. Os dois tipos de stents apresentaram 100% de perviedade, boa biocompatibilidade e boa incorporação a parede aórtica de suínos normolipêmicos. A camada íntima proximal do grupo de stents revestidos com dacron apresentou espessura maior do que os stents não revestidos, mas com significância estatísitica limítrofe. / Stents are intravascular devices implanted with the objective of dilating or fixing the cholesterol plate against the arterial wall. To evaluate, by digital morphometry, the intimal thickening after the placement of two different kinds of stents: polyester covered stainless steel stents (Dacron) and non-covered stents implanted in young pigs’ infrarenal aortas. The stents were made at the Biotransformation Laboratory of Federal University of Rio Grande do Sul. The experiment was performed at the Biotério of University of Caxias do Sul, carried out on two separate groups of pigs. Eight polyester-covered stainless steel stents (Dacron) and eight stainless steel stents (30-mm long, 8-mm diameter) were deployed through extraperitoneal approach in the normal infrarenal aorta of 16 normolipemic pigs. To allow the passage of the delivery system, a small arteriotomy was performed (phase I). After four weeks, the aorta with the stent was removed en bloc. (phase II). The values of the hematimetric and lipid analysis did not show any changes that could influence the study. Tissue samples of the fixing sites (proximal and distal) of the stents were taken. Microscope slices were prepared and submitted to Verhoeff’s hematoxilin and eosin techniques and sent to morphometric analysis.The intima immediately proximal to the device was thicker in the group of covered stents with marginal significance. The distal intimal layer, proximal medial layer of the proximal portion and distal portion did not present statistical difference between the two groups. Patency was 100% in both groups of these normolipemic pigs. After four weeks the intimal layer immediately proximal to the covered stents was ticker when compared to uncovered stents, but this had a borderline significance. The intimal layer distal to covered stents and the media proximal or distal to the devices had similar morphometric features when covered and uncovered stents where compared.