Scanning electron microscopy analysis of luminal inflammation induced by different types of coronary stent in an animal model

Abstract

There is histological evidence that drug-eluting stents are associated with delayed endothelialization and a persistent inflammatory state. Moreover, clusters of inflammatory cells have been observed on luminal surfaces by scanning electron microscopy. With the aim of quantifying this inflammatory response, we implanted one bare-metal stent and two drug-eluting stents containing different doses of vinblastine embedded in the same polymer into the coronary arteries of 12 domestic pigs. The density of inflammatory cells in a representative area (100 x 100 μm) was quantified at 3 and 7 days. Endothelialization was more complete in bare-metal stents than in drug-eluting stents at both 3 days (P=.016) and 7 days (P=.0001). The degree of inflammation induced by the drug-eluting stents was higher than that induced by the bare-metal stents at both 3 days (11.8±3.5% vs. 4.5±2%; P=.001) and 7 days (26.3±4.4% vs. 1.2±1.5%; P=.0001). In addition, the time sequence was inverted: the inflammatory response increased over time with the drug-eluting stents, while the opposite occurred with the bare-metal stents.