Correlated microscopic observations of arterial responses to intravascular stenting

Percutaneous catheter implantation of intravascular stent prostheses has emerged as a novel clinical adjunct to balloon angioplasty in the treatment of obstructive atherosclerotic vascular disease. We have examined the cellular and subcellular responses to stenting in the coronary arteries of the dog and pig (both normal and atherosclerotic), and in the iliac arteries and aorta of the atherosclerotic rabbit, using scanning electron, transmission electron, and light microscopies. Stenting in these models resulted in a thrombotic reaction ranging from mild to severe, depending on species and antithrombotic therapy. Subsequent organization of thrombotic material with hyperplasia of smooth muscle and inflammatory cells, luminal recovering with endothelial or pseudoendothelial cells, and atrophy of the tunica media led to incorporation of the prosthesis into the arterial wall. Endothelial or pseudoendothelial cells were observed adherent to the prosthesis as early as one day after placement, and regeneration of a confluent periluminal cell layer occurred within 2 to 4 weeks. Persistent ultrastructural abnormalities of the periluminal cell layer were seen as late as 2 years after stenting, but the intimal hyperplastic response appeared limited.