title: Improved neo-endothelialization of small diameter ePTFE grafts with titanium coating.
abstract: BACKGROUND
  Patency of small synthetic bypass grafts is inferior compared to autologous grafts for revascularization procedures. Titanium coating of foreign surfaces has shown to decrease thrombogenicity, enhance biocompatibility and promote adhesion of endothelial cells. The aim of this study was to test the effect of titanium coating of small diameter ePTFE grafts on short term patency, neo-endothelialization and neointimal proliferation.
  
  
  METHODS
  Bilateral carotid graft interposition was performed in 5 pigs with uncoated (n=5) and titanium-coated (n=5) ePTFE grafts (internal diameter=4 mm, length=5 cm), thus each pig served as its own control. At the end of the study (30 +/- 3 days), patency and stenosis severity was assessed by carotid angiography. Animals were sacrificed and grafts were excised for histology and scanning electron microscopy. Morphometry of histologic sections was carried out to determine neointimal proliferation and percentage of neo-endothelial coverage.
  
  
  RESULTS
  Patency rate was 80% for uncoated and titanium-coated grafts. Quantitative angiography did not show any significant difference in lumen size between two groups. Morphometry revealed a significantly higher cellular coverage with CD31 positive endothelial cells for titanium-coated (84 +/- 19%) than uncoated grafts (48 +/- 26%, p<0.001). There was a non significant trend (p=0.112) towards increased neointimal proliferation in titanium-coated (94 +/- 61 micron2/micron) compared to uncoated grafts (60 +/- 57 micron2/micron).
  
  
  CONCLUSIONS
  Patency rate in uncoated and titanium-coated ePTFE grafts is similar at one month. However, titanium coated grafts show a significant improvement in neo-endothelialization compared to uncoated grafts.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital, Geneva, Switzerland. mustafa.cikirikcioglu@hcuge.ch
authors.forename: M
authors.initials: M
authors.lastname: Cikirikcioglu
authors.forename: N
authors.initials: N
authors.lastname: Sedelnikov
authors.forename: S
authors.initials: S
authors.lastname: Osorio-Da Cruz
authors.forename: E
authors.initials: E
authors.lastname: Khabiri
authors.forename: A
authors.initials: A
authors.lastname: Donmez Antal
authors.forename: T
authors.initials: T
authors.lastname: Tatar
authors.forename: J-C
authors.initials: JC
authors.lastname: Tille
authors.forename: O M
authors.initials: OM
authors.lastname: Hess
authors.forename: A
authors.initials: A
authors.lastname: Kalangos
authors.forename: B H
authors.initials: BH
authors.lastname: Walpoth
mesh_terms: D000818:Animals; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D002339:Carotid Arteries; D020099:Coated Materials, Biocompatible; D006083:Graft Occlusion, Vascular / Q000473:pathology / Q000517:prevention & control*; D008855:Microscopy, Electron, Scanning; D011138:Polytetrafluoroethylene; D013552:Swine; D014025:Titanium
chemical_list: D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene; D014025:Titanium