Key result
Under simulated COVID-19 cytokine storm conditions, fluoropolymer-coated COBRA stents demonstrated significantly lower platelet adhesion compared to uncoated COBRA, Resolute Onyx, and Synergy stents (P≤0.0001).
Why the study?
Cytokine storm-related hypercoagulation may contribute to stent thrombosis in SARS-CoV-2, but whether stent polymers behave differently under these conditions had not been explored.
Do different stent polymers exhibit varying thrombogenic potential under simulated COVID-19 cytokine storm conditions?
Do different stent polymers exhibit varying thrombogenic potential under simulated COVID-19 cytokine storm conditions?
p-value: p=≤0.0001
Fluoropolymer-coated stents demonstrate favorable anti-thrombogenic and anti-inflammatory properties under simulated COVID-19 cytokine storm conditions in vitro.
Stent polymer performance in cytokine storm conditions remains unproven clinically; leaves open whether coating choice affects thrombosis risk in SARS-CoV-2.
Cytokine storm-related hypercoagulation may be important in the pathogenesis of stent thrombosis in patients with SARS-CoV-2. Whether stent polymers behave differently under such conditions has never been explored. Fluorinated polymer-nanocoated and uncoated COBRA stents (CeloNova), BioLinx-polymer-coated Resolute Onyx stents (Medtronic), and Synergy stents (Boston Scientific), which are abluminally coated with a bioabsorbable polymer, were exposed to human blood from healthy donors which was supplemented with 400 pg/mL IL-6 and 100 pg/mL TNF-α, similar to what is seen in cytokine storm caused by SARS-CoV-2. Platelet adhesion and neutrophil activation, assessed by immunofluorescence, were compared under cytokine storm and control conditions (untreated blood) (n = 4 experimental runs). Platelet adhesion values, defined as %platelet-covered area x staining intensity, were significantly lower in coated and uncoated COBRA and in Resolute Onyx than in Synergy under control conditions (1.28 × 107 ± 0.43 × 107 vs. 2.92 × 107 ± 0.49 × 107 vs. 3.57 × 107 ± 0.73 × 107 vs. 9.94 × 107 ± 0.99 × 107; p ≤0.0001). In cytokine storm, platelet adhesion values remained low in coated COBRA-PzF (1.78 × 107 ± 0.38 × 107) compared to all other devices (uncoated COBRA: 5.92 × 107 ± 0.96 × 107; Resolute Onyx: 7.27 × 107 ± 1.82 × 107; Synergy: 11.28 × 107 ± 1.08 × 107; p ≤ 0.0001). Although cytokine storm conditions significantly increased neutrophil activation in all stents, it was significantly less in coated and uncoated COBRA, and in Resolute Onyx than in Synergy. Blood-biomaterials interactions may determine the thrombogenic potential of stents. Under simulated cytokine storm conditions, fluoropolymer-coated stents showed the most favorable anti-thrombogenic and anti-inflammatory properties.
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Cornelissen et al. (2021) studied Simulated COVID-19 cytokine storm (n=4). Fluorinated polymer-nanocoated COBRA stents vs. Uncoated COBRA, Resolute Onyx, and Synergy stents was evaluated on Platelet adhesion values (%platelet-covered area x staining intensity) under cytokine storm (p=≤0.0001). Under simulated COVID-19 cytokine storm conditions, fluoropolymer-coated COBRA stents demonstrated significantly lower platelet adhesion compared to uncoated COBRA, Resolute Onyx, and Synergy stents (P≤0.0001).
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