Open AccessVery Late Pathological Responses to Cobalt–Chromium Everolimus‐Eluting, Stainless Steel Sirolimus‐Eluting, and Cobalt–Chromium Bare Metal Stents in Humans
Author(s) -
Mori Hiroyoshi,
Atmakuri Dheeraj R.,
Torii Sho,
Braumann Ryan,
Smith Samantha,
Jinnouchi Hiroyuki,
Gupta Anuj,
Harari Emanuel,
Shkullaku Melsi,
Kutys Robert,
Fowler David,
Romero Maria,
Virmani Renu,
Finn Aloke V.
Publication year - 2017
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.117.007244
Subject(s) - medicine , everolimus , stent , inflammation , sirolimus , chromium , bare metal stent , giant cell , cardiology , gastroenterology , urology , surgery , pathology , drug eluting stent , restenosis , metallurgy , materials science
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.