Summary. Cell therapy is proposed for indirect revascularization for the patient’s incurable by endovascular or surgical revascularization. The therapy with stem cells (SCs) or progenitor cells is assumed to be more efficient as compared with protein or gene therapy not only because of their direct vasculogenic properties, but also thanks to their paracrine effect via secretion of manifold biologically active substances. This review gives an overview of the potential of SC-based therapy for critical limb ischemia (CLI), putative mechanism underlying cell therapy, and comparison of cell therapy to angiogenesis gene therapy in CLI treatment. Human trial data and meta-analysis, as well as some problems of clinical trials and considerations for future SC-based therapy in CLI are also discussed.

Purpose: The efficacy and safety of the Supera stent in superficial femoral artery (SFA) have been reported mostly in shorter lesions with relatively low proportion of occlusions. There are little data on the effectiveness of the Supera stent in long lesions. The aim of this study was to assess the clinical safety and efficiency of the Supera stent in the treatment of long femoropopliteal occlusive lesions (Trans-Atlantic Inter-Society Consensus [TASC] C/D) in patients with symptomatic peripheral artery disease. Materials and Methods: The STELLA-SUPERA-SIBERIA is a prospective, single-center, single-arm study. Patients with symptomatic (Rutherford stages 3–6) de novo and TASC C/D occlusive lesions of the femoropopliteal segment were treated with Supera stent. The primary endpoint was the 12 month rate of primary sustained clinical improvement (upward shift on the Rutherford classification to a one level without the need for repeated target lesion revascularization (TLR) in surviving patients without the need for unplanned amputation). Secondary endpoints were the 24 month of primary sustained clinical improvement, MALE, limb salvage, the primary patency, the secondary patency, 24 month MACE. Follow-up included clinical examination, duplex scan, and biplane x-ray up to 24 months. Results: Between April 2019 and January 2020, 52 symptomatic patients with 55 long femoropopliteal occlusive lesions (52.7% TASC D lesions and 47.3% TASC C lesions) were treated. The mean target lesion length was 205±72 mm. All patients had total occlusions. The mean lesion length of the implanted Supera stents was 198±82 mm. At 12 and 24 months, the primary sustained clinical improvement rate was 80.2% and 63.6%, respectively. The Rutherford category assessment was significantly improved at 24 months compared with baseline (p=0.02). The primary patency rate at 12 and 24 months was 78.1% and 60.0%, respectively. At 12 and 24 months, freedom from TLR was 83.5% and 81.8%, respectively. There were no stent fractures at 24 months. Conclusion: Supera Stent implantation for TASC C/D femoropopliteal lesions revascularization appears to be a safe and efficient implant given the complexity of the treated lesions. Head-to-head studies are mandatory to establish Supera Stent as an alternative tool to open surgery for long femoropopliteal lesions. Clinical Impact: Our study indicated, that using self-expanding interwoven nitinol stent for TASC C/D femoropopliteal lesions revascularization appears to be a safe and efficient implant given the complexity of the treated lesions. Although bypass grafting is recommended for prolonged femoropopliteal lesions, open surgery is more traumatic and is associated with greater risks than endovascular procedures. Our findings suggest that the use of interwoven nitinol stents can overcome the disadvantages of traditional stents in such cases, which may help to improve patients’ outcomes and reduce the risk of adverse events.

Bioengineered vascular grafts (VGs) have emerged as a promising alternative to the treatment of damaged or occlusive vessels. It is thought that polyurethane (PU)-based scaffolds possess suitable hemocompatibility and biomechanics comparable to those of normal blood vessels. In this study, we investigated the properties of electrospun scaffolds comprising various blends of biostable polycarbonate-based PU (Carbothane™ 3575A) and gelatin. Scaffolds were characterized by scanning electron microscopy, infra-red spectroscopy, small-angle x-ray scattering, stress-loading tests, and interactions with primary human cells and blood. Data from in vitro experiments demonstrated that a scaffold produced from a blend of 5% Carbothane™ 3575A and 10% gelatin has proven to be a suitable material for fabricating a small-diameter VG. A comparative in vivo study of such VGs and expanded polytetrafluoroethylene (ePTFE) grafts implanted in the abdominal aorta of Wistar rats was performed. The data of intravital study and histological examination indicated that Carbothane-based electrospun grafts outclass ePTFE grafts and represent a promising device for preclinical studies to satisfy vascular surgery needs.

Исходы применения различных конструкций каротидных стентов

Современные подходы к реваскуляризации бедренно-подколенных поражений. Достижения и перспективы