Effect of stents coated with a combination of sirolimus and alpha-lipoic acid in a porcine coronary restenosis model

The aim of this study was to evaluate antiproliferative sirolimus- and antioxidative alpha-lipoic acid (ALA)-eluting stents using biodegradable polymer [poly-l-lactic acid (PLA)] in a porcine coronary overstretch restenosis model. Forty coronary arteries of 20 pigs were randomized into four groups in which the coronary arteries had a bare metal stent (BMS, n = 10), ALA-eluting stent with PLA (AES, n = 10), sirolimus-eluting stent with PLA (SES, n = 10), or sirolimus- and ALA-eluting stent with PLA (SAS, n = 10). A histopathological analysis was performed 28 days after the stenting. The ALA and sirolimus released slowly over 30 days. There were no significant differences between groups in the injury or inflammation score; however, there were significant differences in the percent area of stenosis (56.2 ± 11.78 % in BMS vs. 51.5 ± 12.20 % in AES vs. 34.7 ± 7.23 % in SES vs. 28.7 ± 7.30 % in SAS, P < 0.0001) and fibrin score [1.0 (range 1.0–1.0) in BMS vs. 1.0 (range 1.0–1.0) in AES vs. 2.0 (range 2.0–2.0) in SES vs. 2.0 (range 2.0–2.0) in SAS, P < 0.0001] between the four groups. The percent area of stenosis based on micro-computed tomography corresponded with the restenosis rates based on histopathological stenosis in different proportions in the four groups (54.8 ± 7.88 % in BMS vs. 50.4 ± 14.87 % in AES vs. 34.5 ± 7.22 % in SES vs. 28.9 ± 7.22 % in SAS, P < 0.05). SAS showed a better neointimal inhibitory effect than BMS, AES, and SES at 1 month after stenting in a porcine coronary restenosis model. Therefore, SAS with PLA can be a useful drug combination for coronary stent coating to suppress neointimal hyperplasia.