A Design-Based Stereologic Method to Quantify the Tissue Changes Associated with a Novel Drug-Eluting Tracheobronchial Stent

Labib Debiane, Ruth Reitzel, Joel Rosenblatt, Mihai Gagea Iurascu, Miguel A. Chavez, Roberto Adachi, Horiana Bogdana Grosu, Ajay Sheshadri, Lorraine R Hill, Issam I Raad, David Ost

Research output: Contribution to journalArticle

Abstract

Background: Granulation tissue is a common complication of airway stenting, but no published methods can quantify the volume and type of tissue that develops. Objective: To use design-based stereology to quantify changes in tissue volume and type associated with airway stenting. Methods: We compared drug-eluting stents (DES) filled with gendine to standard silicone stents in pigs in an assessor-blinded randomized trial. Tracheal stents were placed via rigid bronchoscopy. After 1 month, animals were euthanized and necropsies were performed. Antimicrobial effects of the DES were assessed in trachea tissue samples, on the DES surface, and with residual gel from the DES reservoir. Tracheal thickness was measured using orthogonal intercepts. Design-based stereology was used to quantify the volume density of tissues using a point-counting method. The volume of each tissue was normalized to cartilage volume, which is unaffected by stenting. Results: Pigs were randomized to DES (n = 36) or control stents (n = 9). The drug was successfully eluted from the DES, and the stent surface showed antibacterial activity. DES and controls did not differ in tissue microbiology, tracheal thickness, or granulation tissue volume. Compared to nonstented controls, stented airways demonstrated a 110% increase in soft-tissue volume (p = 0.005). Submucosal connective tissue (118%; p < 0.0001), epithelium (70%; p < 0.0001), submucosal glands (47%; p = 0.001), and smooth muscle (41%; p < 0.0001) increased in volume. Conclusion: Stenting doubles the volume of soft tissue in the trachea. Design-based stereology can quantify the tissue changes associated with airway stenting.

Original languageEnglish (US)
JournalRespiration
DOIs
StatePublished - Jan 1 2019

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Drug-Eluting Stents
Stents
Granulation Tissue
Trachea
Swine
Airway Management
Bronchoscopy
Silicones
Microbiology
Connective Tissue
Cartilage
Smooth Muscle
Epithelium
Gels

Keywords

  • Airway stenting
  • Drug-eluting stent
  • Granulation tissue
  • Stereology

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

@article{60756f0c63454b8490f25a047a902e52,
title = "A Design-Based Stereologic Method to Quantify the Tissue Changes Associated with a Novel Drug-Eluting Tracheobronchial Stent",
abstract = "Background: Granulation tissue is a common complication of airway stenting, but no published methods can quantify the volume and type of tissue that develops. Objective: To use design-based stereology to quantify changes in tissue volume and type associated with airway stenting. Methods: We compared drug-eluting stents (DES) filled with gendine to standard silicone stents in pigs in an assessor-blinded randomized trial. Tracheal stents were placed via rigid bronchoscopy. After 1 month, animals were euthanized and necropsies were performed. Antimicrobial effects of the DES were assessed in trachea tissue samples, on the DES surface, and with residual gel from the DES reservoir. Tracheal thickness was measured using orthogonal intercepts. Design-based stereology was used to quantify the volume density of tissues using a point-counting method. The volume of each tissue was normalized to cartilage volume, which is unaffected by stenting. Results: Pigs were randomized to DES (n = 36) or control stents (n = 9). The drug was successfully eluted from the DES, and the stent surface showed antibacterial activity. DES and controls did not differ in tissue microbiology, tracheal thickness, or granulation tissue volume. Compared to nonstented controls, stented airways demonstrated a 110{\%} increase in soft-tissue volume (p = 0.005). Submucosal connective tissue (118{\%}; p < 0.0001), epithelium (70{\%}; p < 0.0001), submucosal glands (47{\%}; p = 0.001), and smooth muscle (41{\%}; p < 0.0001) increased in volume. Conclusion: Stenting doubles the volume of soft tissue in the trachea. Design-based stereology can quantify the tissue changes associated with airway stenting.",
keywords = "Airway stenting, Drug-eluting stent, Granulation tissue, Stereology",
author = "Labib Debiane and Ruth Reitzel and Joel Rosenblatt and {Gagea Iurascu}, Mihai and Chavez, {Miguel A.} and Roberto Adachi and Grosu, {Horiana Bogdana} and Ajay Sheshadri and Hill, {Lorraine R} and Raad, {Issam I} and David Ost",
year = "2019",
month = "1",
day = "1",
doi = "10.1159/000496152",
language = "English (US)",
journal = "Respiration; international review of thoracic diseases",
issn = "0025-7931",
publisher = "S. Karger AG",

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TY - JOUR

T1 - A Design-Based Stereologic Method to Quantify the Tissue Changes Associated with a Novel Drug-Eluting Tracheobronchial Stent

AU - Debiane, Labib

AU - Reitzel, Ruth

AU - Rosenblatt, Joel

AU - Gagea Iurascu, Mihai

AU - Chavez, Miguel A.

AU - Adachi, Roberto

AU - Grosu, Horiana Bogdana

AU - Sheshadri, Ajay

AU - Hill, Lorraine R

AU - Raad, Issam I

AU - Ost, David

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Granulation tissue is a common complication of airway stenting, but no published methods can quantify the volume and type of tissue that develops. Objective: To use design-based stereology to quantify changes in tissue volume and type associated with airway stenting. Methods: We compared drug-eluting stents (DES) filled with gendine to standard silicone stents in pigs in an assessor-blinded randomized trial. Tracheal stents were placed via rigid bronchoscopy. After 1 month, animals were euthanized and necropsies were performed. Antimicrobial effects of the DES were assessed in trachea tissue samples, on the DES surface, and with residual gel from the DES reservoir. Tracheal thickness was measured using orthogonal intercepts. Design-based stereology was used to quantify the volume density of tissues using a point-counting method. The volume of each tissue was normalized to cartilage volume, which is unaffected by stenting. Results: Pigs were randomized to DES (n = 36) or control stents (n = 9). The drug was successfully eluted from the DES, and the stent surface showed antibacterial activity. DES and controls did not differ in tissue microbiology, tracheal thickness, or granulation tissue volume. Compared to nonstented controls, stented airways demonstrated a 110% increase in soft-tissue volume (p = 0.005). Submucosal connective tissue (118%; p < 0.0001), epithelium (70%; p < 0.0001), submucosal glands (47%; p = 0.001), and smooth muscle (41%; p < 0.0001) increased in volume. Conclusion: Stenting doubles the volume of soft tissue in the trachea. Design-based stereology can quantify the tissue changes associated with airway stenting.

AB - Background: Granulation tissue is a common complication of airway stenting, but no published methods can quantify the volume and type of tissue that develops. Objective: To use design-based stereology to quantify changes in tissue volume and type associated with airway stenting. Methods: We compared drug-eluting stents (DES) filled with gendine to standard silicone stents in pigs in an assessor-blinded randomized trial. Tracheal stents were placed via rigid bronchoscopy. After 1 month, animals were euthanized and necropsies were performed. Antimicrobial effects of the DES were assessed in trachea tissue samples, on the DES surface, and with residual gel from the DES reservoir. Tracheal thickness was measured using orthogonal intercepts. Design-based stereology was used to quantify the volume density of tissues using a point-counting method. The volume of each tissue was normalized to cartilage volume, which is unaffected by stenting. Results: Pigs were randomized to DES (n = 36) or control stents (n = 9). The drug was successfully eluted from the DES, and the stent surface showed antibacterial activity. DES and controls did not differ in tissue microbiology, tracheal thickness, or granulation tissue volume. Compared to nonstented controls, stented airways demonstrated a 110% increase in soft-tissue volume (p = 0.005). Submucosal connective tissue (118%; p < 0.0001), epithelium (70%; p < 0.0001), submucosal glands (47%; p = 0.001), and smooth muscle (41%; p < 0.0001) increased in volume. Conclusion: Stenting doubles the volume of soft tissue in the trachea. Design-based stereology can quantify the tissue changes associated with airway stenting.

KW - Airway stenting

KW - Drug-eluting stent

KW - Granulation tissue

KW - Stereology

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U2 - 10.1159/000496152

DO - 10.1159/000496152

M3 - Article

JO - Respiration; international review of thoracic diseases

JF - Respiration; international review of thoracic diseases

SN - 0025-7931

ER -