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(Circulation. 1996;94:3311-3317.)
© 1996 American Heart Association, Inc.

Articles

Antithrombotic Potential of Polymer-Coated Stents Eluting Platelet Glycoprotein IIb/IIIa Receptor Antibody

Rajesh K. Aggarwal, MB, MRCP; Deborah C. Ireland, PhD; Michael A. Azrin, MD; Michael D. Ezekowitz, MD, PhD; David P. de Bono, MD, FRCP; Anthony H. Gershlick, BSc, FRCP

the Division of Cardiology, Faculty of Medicine, University of Leicester, UK (R.K.A., D.C.I., D.P. de B., A.H.G.); the Division of Cardiology, University of Connecticut, Farmington (M.A.A.); and the Section of Cardiovascular Medicine, Yale University, New Haven, Conn (M.D.E.).

Correspondence to Dr R.K. Aggarwal, Department of Cardiology, Regional Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK.

Background Monoclonal anti-rabbit platelet glycoprotein (GP) IIb/IIIa antibody (AZ1) was adsorbed onto cellulose polymer–coated intracoronary stents to enhance their thromboresistance. We evaluated the antithrombotic efficacy of AZ1 antibody–eluting stents.

Methods and Results Twenty-three polymer-coated stents with AZ1 antibody bound by passive adsorption (AZ1-eluting) were compared with 23 control polymer-coated stents adsorbed with either no antibody (base-polymer, n=12) or isotype-matched irrelevant antibody (anti-CMV–eluting, n=11) by implantation into balloon-damaged, flow-reduced iliac arteries of New Zealand White rabbits. In 13 animals (acute group), flow measurements were made with transit-time flow probes and platelet adhesion was ascertained by use of ¹¹¹In-labeled autologous platelets. In the other 10 animals (chronic group), stent occlusion was assessed macroscopically after they were killed 28 days after stenting. Arteries with AZ1-eluting stents had significantly less platelet deposition (15.8±4.5x10⁷) than either base-polymer (32.1±4.3x10⁷) or anti-CMV–eluting (35.2±8.8x10⁷) controls (ANOVA, P<.0001). Compared with base-polymer or anti-CMV–eluting controls, arteries with AZ1-eluting stents showed a marked reduction in cyclic blood flow variation (P<.0001) and a significantly greater mean blood flow 2 hours after stent deployment (P<.0001). There was a significant improvement in the patency rate of AZ1-eluting stents compared with controls at both 2 hours (92% versus 46%, P=.034) and 28 days (100% versus 40%, P=.015).

Conclusions Platelet GP IIb/IIIa antibody eluting from polymer-coated stents reduces platelet deposition, improves blood flow, virtually abolishes cyclic flow variation, and improves patency rates after stent implantation in a rabbit iliac artery model. Its potential for reducing stent-related thrombosis in humans warrants further evaluation.

Key Words: stents • thrombosis • platelet aggregation inhibitors

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