European Heart Journal Advance Access originally published online on April 12, 2007
European Heart Journal 2007 28(8):974-979; doi:10.1093/eurheartj/ehm064
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Drug-eluting stents show delayed healing: paclitaxel more pronounced than sirolimus
1 Department of Cardiology, Ee 2355b, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 50, PO Box 1738, 3000 Rotterdam, The Netherlands
2 Interuniversity Cardiology Institute (ICIN), Utrecht, The Netherlands
Received 7 June 2006; revised 7 February 2007; accepted 8 March 2007; online publish-ahead-of-print 12 April 2007.
* Corresponding author. Tel: +31 10 4088048; fax: +31 10 4089494. E-mail address: h.vanbeusekom{at}erasmusmc.nl
Aims: To understand wound healing after drug-eluting stents (DES) placement in humans, we studied the histology of in-stent restenosis (ISR) tissue obtained by atherectomy from bare metal stents (BMS) and DES in comparison with de novo atherosclerosis.
Methods and results: The tissue was retrieved from ISR in ten sirolimus-eluting stents (SES) and nine paclitaxel-eluting stents (PES), six BMS, and nine stenotic de novo atherosclerotic lesions and processed for histology and immunocytochemistry. Patients with ISR in PES showed a significantly higher incidence of unstable angina upon presentation for re-intervention (P = 0.046). De novo tissue tended to be more collagen rich, whereas ISR tissue tended to be more proteoglycan rich. In all groups, cell content consisted almost exclusively of smooth muscle cells. Histology showed that fibrinoid in ISR tissue was present only in DES (P = 0.004), as late as 2 years following DES placement, indicating a persistent incomplete healing response. The amount of fibrinoid, given as a percentage of total tissue in each atherectomy specimen, was greater in PES than in SES (17 vs. 5%, P = 0.026).
Conclusion: ISR in DES shows incomplete neointimal healing as late as 2 years after implantation. Patients with ISR in PES presented with more unstable angina and showed more pronounced signs of delayed healing than SES.
Key Words: Drug-eluting stent • Restenosis • Delayed healing • Pathology • Atherectomy
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. Takano, M. Yamamoto, D. Murakami, S. Inami, K. Okamatsu, K. Seimiya, T. Ohba, Y. Seino, and K. Mizuno Lack of Association Between Large Angiographic Late Loss and Low Risk of In-Stent Thrombus: Angioscopic Comparison Between Paclitaxel- and Sirolimus-Eluting Stents Circ Cardiovasc Intervent, August 1, 2008; 1(1): 20 - 27. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. R. Holmes Jr and D. O. Williams Catheter-Based Treatment of Coronary Artery Disease: Past, Present, and Future Circ Cardiovasc Intervent, August 1, 2008; 1(1): 60 - 73. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. R. Holmes Jr, P. S. Teirstein, L. Satler, M. H. Sketch Jr, J. J. Popma, L. Mauri, H. Wang, P. A. Schleckser, S. A. Cohen, and SISR Investigators 3-Year Follow-Up of the SISR (Sirolimus-Eluting Stents Versus Vascular Brachytherapy for In-Stent Restenosis) Trial J. Am. Coll. Cardiol. Intv., August 1, 2008; 1(4): 439 - 448. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. T. Newsome, M. A. Kutcher, and R. L. Royster Coronary Artery Stents: Part I. Evolution of Percutaneous Coronary Intervention Anesth. Analg., August 1, 2008; 107(2): 552 - 569. [Abstract] [Full Text] [PDF]
|
|