Transjugular intrahepatic portosystemic shunt with an autologous endothelial progenitor cell seeded stent: a porcine model.
OBJECTIVE
To evaluate the efficacy of a self-expanding metal stent seeded with autologous endothelial progenitor cells (EPCs) for preventing in-stent stenoses in transjugular intrahepatic portosystemic shunt (TIPS) in a swine model.


METHODS
TIPS was performed in 18 young adult pigs, using a self-expanding nitinol stent (control, n = 8) and an autologous EPC-seeded stent (treatment, n = 10). All pigs were sacrificed at 2 weeks post-TIPS procedure. Portography was performed immediately before the euthanasia. Gross, microscopic, and immunohistochemistry of the TIPS tract specimens were examined. The proliferative response of the shunt was quantified histologically.


RESULTS
TIPS was performed successfully in 16 swine, 2 animals died during the procedure. Another pig died of unknown causes 2 days post-procedure. At day 14 follow-up, portography and necropsy of the 15 remaining swine demonstrated that five shunts occluded and one shunt was stenotic (80%) in the control group (n = 6). Five shunts remained patent, two shunts were stenosed (50%, 70%), and the remaining two shunts were occluded in the treatment group (n = 9). The patency rate was significantly lower in the control group than in the treatment group, 0% versus 55.6% (P = .03). Histological analyses showed a significantly greater pseudointimal hyperplasia in the TIPS track of the control group than that of the treatment group (P < .05). Intact endothelium was documented in the lumina of all the EPC-implanted stent group.


CONCLUSIONS
The EPC-seeded metal stent is feasibly fabricated in vitro and improves the patency in TIPS in a porcine model.
Shi
Hong-Jian
HJ
Department of Radiology, Zhongda Hospital, Southeast University, Nanjing, China, 210009.
Cao
Ai-Hong
AH
Chen
Jun
J
Deng
Gang
G
Teng
Gao-Jun
GJ
D000818:Animals; D001807:Blood Vessel Prosthesis; D002478:Cells, Cultured; D004195:Disease Models, Animal; D042783:Endothelial Cells / Q000637:transplantation*; D019544:Equipment Failure Analysis; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000517:prevention & control*; D006801:Humans; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D011474:Prosthesis Design; D033581:Stem Cell Transplantation / Q000295:instrumentation*; D015607:Stents; D013552:Swine