title: Granulomatous 'foreign body reactions' contribute to exaggerated in-stent restenosis.
abstract: BACKGROUND
  Results of previous studies with stents coated with 'biocompatible' polymers showed that severe inflammatory reaction and subsequent in-stent restenosis may occur.
  
  
  OBJECTIVE
  To evaluate the contribution of granulomatous reaction from uncoated stents to formation of in-stent neointimal hyperplasia.
  
  
  METHODS
  Uncoated stainless-steel stents were implanted into 21 porcine coronary arteries without oversizing and harvested after 2 months (n = 6) or 6 months (n = 7). We compared the stents with granulomatous reaction with those without foreign-body reaction.
  
  
  RESULTS
  Granulomatous reactions occurred in five 21 stents and resulted in there being significantly greater in-stent neointimal hyperplasia than there was with stents without foreign-body reaction (angiographic diameter stenosis 45 +/- 36 versus 16 +/- 16%, area of neointimal 3.30 +/- 1.4 versus 1.22 +/- 0.4 mm2, thickness of neointima 0.46 +/- 0.29 versus 0.11 +/- 0.09 mm, stenosed area 56 +/- 24 versus 20 +/- 7%, P < 0.01 for each comparison). This increase in amount of neointima was accompanied by significantly greater proliferating cell nuclear antibody staining (15 +/- 5 versus 3 +/- 2%, P < 0.05) in the presence of a granuloma near the stent struts.
  
  
  CONCLUSIONS
  A localized granulomatous reaction is associated with a significant increase in amount of stent neointima and proliferation of cells. Thus, permanent stent implants may provoke granulomatous vascular reactions that may affect late-healing responses and clinical outcomes.
authors: Cardiology Division, Washington Hospital Center, USA.
authors: R
authors: R
authors: Kornowski
authors: M K
authors: MK
authors: Hong
authors: R
authors: R
authors: Virmani
authors: R
authors: R
authors: Jones
authors: Y
authors: Y
authors: Vodovotz
authors: M B
authors: MB
authors: Leon
mesh_terms: D000818:Animals; D003327:Coronary Disease / Q000473:pathology* / Q000628:therapy; D003331:Coronary Vessels / Q000473:pathology*; D015745:Granuloma, Foreign-Body / Q000473:pathology*; D006965:Hyperplasia; D018809:Proliferating Cell Nuclear Antigen / Q000032:analysis; D012008:Recurrence; D013193:Stainless Steel; D015607:Stents; D013552:Swine; D017539:Tunica Intima / Q000473:pathology
chemical_list: D018809:Proliferating Cell Nuclear Antigen; D013193:Stainless Steel