Investigadores del Instituto de Investigación Germans Trias i Pujol (IGTP) y del CIBERCV, liderados por el Antoni Bayés Genís, junto con el grupo de Magnetismo del Departamento de Física de la Materia Condensada de la Universidad de Barcelona, liderado por el profesor Javier Tejada y Ferran Macià, y el grupo CommSensLab de la Universitat Politècnica de Catalunya (UPC) (Catalunya, España), dirigido por el profesor Joan O’Callaghan, han desarrollado una nueva sonda de campo cercano para detectar de manera no invasiva y no ionizante la presencia de los estents metálicos, así como sus posibles distorsiones estructurales mediante espectrometría de microondas (MWS). Los resultados se han publicado en la revista científica Scientific Reports.
La enfermedad arterial coronaria (EAC) es la principal causa de muerte en los países desarrollados. Por lo general es causada por la aterosclerosis, caracterizada por acúmulos de colesterol y otras sustancias grasas en la pared de las arterias que pueden llegar a formar coágulos sanguíneos que obstruyen las arterias coronarias (trombosis coronaria) y son responsables de patologías como la angina o el infarto de miocardio. El tratamiento de la EAC comprende cambios en el estilo de vida para modificar los factores de riesgo coronario y distintos fármacos, pero cuando las obstrucciones coronarias son importantes, es necesario realizar un tratamiento de revascularización mediante intervencionismo coronario percutáneo (ICP) o bien cirugía coronaria.
El ICP es un procedimiento mínimamente invasivo mediante el cual se realiza una dilatación con balón en lugar de la obstrucción y se implanta una pequeña prótesis cilíndrica de metal llamada estent. En algunos casos, con el paso del tiempo el estent coronario puede fallar debido a un proceso de restenosis, es decir, la proliferación de las células de la pared vascular que termina obstruyendo el estent, o por un proceso de trombosis, cuando sucede una obstrucción súbita del estent por la formación de un trombo en su interior. Distintos fenómenos se han visto relacionados con un mayor riesgo de estos fallos: puede producirse un proceso de fractura de la estructura metálica del estent; en otros casos puede haber una falta de contacto entre la pared arterial y el estent (aposición incompleta); o en ocasiones se produce una expansión incompleta del stent que disminuye el calibre en su interior.
Actualmente no existe una tecnología disponible que permita detectar de forma no invasiva fenómenos como la fractura, aposición incompleta o expansión incompleta del estent o incluso la presencia de restenosis. “Técnicas invasivas como la angiografía coronaria, la ecografía intravascular o la tomografía de coherencia óptica son de elevado coste y su uso no se puede generalizar en todos los pacientes con stents coronarios”, detalla Carolina Gálvez-Montón, primera autora del artículo. Además se trata de técnicas complejas que requieren maquinaria muy específica que no se encuentra fuera de grandes hospitales.
“La sonda de campo cercano consiste en un dispositivo del tamaño de un dedo que emite una onda electromagnética parecida a las ondas de la telefonía móvil y que detecta a su vez las modificaciones ocasionadas a dicha onda a causa del estent implantado” explica Ferran Macià de la UB.
Para probar esta nueva sonda, “se ha realizado la implantación subcutánea de estents en un modelo murino donde se ha detectado la presencia de los dispositivos así como sus cambios derivados de la restenosis y la fractura mediante la variación de frecuencias de resonancia características en los espectros de absorbancia de microondas, que reflejan la ocurrencia de cambios en la longitud del estent o el diámetro”, explica Gálvez-Montón. Como resultado, puesto que los estents se fueron colonizando con tejido fibrótico como respuesta natural a su implantación subcutánea, la nueva sonda detectó diferencias significativas de su contenido entre su implantación basal y a los 30 días de seguimiento (restenosis). Finalmente se pudo diferenciar mediante espectrometría de microondas los estents que estaban fracturados de los que seguían siendo íntegros.
En conclusión, según comenta Antoni Bayés Genís, “se necesitan más estudios para confirmar estos resultados y creemos que es necesario trasladar estos experimentos a nivel pre-clínico en un modelo animal similar al humano, y en caso de corroborarse, validar esta nueva tecnología en una pequeña cohorte de pacientes”.
“Estamos abordando los aspectos tecnológicos que permitan realizar los experimentos pre-clínicos y su eventual traslado a una aplicación clínica”, explica Joan O’Callaghan, investigador de la UPC, “ello incluye, entre otros, el desarrollo de dispositivos con capacidad de detectar estents a mayor profundidad y técnicas de detección que toleren el movimiento de estents implantados en arterias coronarias”. (Fuente: UPC)
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