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Background  The “very late” clinical outcomes for durable polymer drug‐eluting stents and bare metal stents ( BMSs ) have been shown to be dissimilar in clinical studies. Conceptually, the long‐term vascular compatibility of  BMSs  is still regarded to be superior to drug‐eluting stents; however, no pathologic study to date has specifically addressed this issue. We evaluated the very late (≥1 year) pathologic responses to durable polymer drug‐eluting stents (cobalt–chromium [CoCr] everolimus‐eluting stents [ EESs ] and stainless steel sirolimus‐eluting stents [ SS ‐ SESs ]) versus  BMSs  (CoCr‐ BMSs ).    Methods and Results  From the  CVP ath stent registry, we studied a total of 119 lesions (40 CoCr‐ EESs , 44  SS ‐ SES s, 35 CoCr‐ BMS s) from 92 autopsy cases with a duration ranging from 1 to 5 years. Sections of stented coronary segments were pathologically analyzed. Inflammation score and the percentage of struts with giant cells were lowest in CoCr‐ EESs  (median inflammation score: 0.6; median percentage of struts with giant cells: 3.8%) followed by CoCr‐ BMSs  (median inflammation score: 1.3 [ P <0.01]; median percentage of struts with giant cells: 8.9% [ P =0.02]) and SS‐ SESs  (median inflammation score: 1.7 [ P <0.01]; median percentage of struts with giant cells: 15.3% [ P <0.01]). Polymer delamination was observed exclusively in  SS ‐ SESs  and was associated with increased inflammatory and giant cell reactions. The prevalence of neoatherosclerosis with CoCr‐ EESs  (50%) was significantly less than with  SS ‐ SESs  (77%,  P =0.02) but significantly greater than with CoCr‐ BMSs  (20%,  P <0.01).    Conclusions  CoCr‐ EESs ,  SS ‐ SESs , and  BMSs  each demonstrated distinct vascular responses. CoCr‐ EESs  demonstrated the least inflammation, near‐equivalent healing to  BMSs , and lower neointimal formation. These results challenge the belief that  BMSs  have superior biocompatibility compared with some polymeric coated drug‐eluting stents and may have implications for future stent design.

journal of the american heart association

Very Late Pathological Responses to Cobalt–Chromium Everolimus‐Eluting, Stainless Steel Sirolimus‐Eluting, and Cobalt–Chromium Bare Metal Stents in Humans