This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Windecker, S. Articles by Hess, O. M. Search for Related Content PubMed PubMed Citation Articles by Windecker, S. Articles by Hess, O. M. Related Collections Restenosis Animal models of human disease Smooth muscle proliferation and differentiation Catheter-based coronary interventions: stents Coronary circulation

(Circulation. 2001;104:928.)
© 2001 American Heart Association, Inc.

Basic Science Reports

Stent Coating With Titanium-Nitride-Oxide for Reduction of Neointimal Hyperplasia

Stephan Windecker, MD; Isabella Mayer, MD; Gabriella De Pasquale, BA; Willibald Maier, MD; Olaf Dirsch, MD; Philip De Groot, MD; Ya-Ping Wu, PhD; Georg Noll, MD; Boris Leskosek, BA; Bernhard Meier, MD; Otto M. Hess, MD; , in collaboration with the Working Group on Novel Surface Coating of Biomedical Devices (SCOL)

From Cardiology, Swiss Cardiovascular Center Bern, University Hospital Bern (S.W., G.D.P., W.M., B.M., O.M.H.), and Cardiology (G.N.) and Experimental Surgery (I.M., O.D., B.L.), University Hospital Zurich, Switzerland; and Hematology, University of Utrecht, Netherlands (P.D.G., Y.P.W.).

Correspondence to Otto M. Hess, MD, FESC, Professor of Medicine, Swiss Cardiovascular Center, University Hospital, 3010 Bern, Switzerland. E-mail otto.martin.hess@ insel.ch

Background—— Coronary stents prevent constrictive arterial remodeling but stimulate neointimal hyperplasia. Stainless steel induces a metallic foreign body reaction, which is absent for titanium. The hypothesis of the present study was that titanium renders the stent surface biologically inert, with reduced platelet and fibrinogen binding.

Methods and Results—— Twelve pigs were instrumented with a stainless steel and 2 titanium-nitride-oxide–coated stents (TiNOX 1, ceramic; TiNOX 2, metallic). Animals were restudied after 6 weeks. Histological specimens of stented segments were analyzed by digital morphometry. Platelet adhesion and fibrinogen binding studies were performed in the perfusion chamber. Under in vitro conditions, TiNOX 1 showed reduced platelet adhesion (65±3%) compared with TiNOX 2 (72±5%; P<0.05) and stainless steel (71±4%; P<0.05). Platelet adhesion 48 hours after incubation with human plasma, however, was not different between TiNOX 1 (17±3%) and 2 (15±3%) but was significantly higher with stainless steel (23±2%; P<0.05). Fibrinogen binding was significantly reduced with TiNOX 2 (54±3%) compared with TiNOX 1 (82±4%, P<0.05) or stainless steel (100%, P<0.05). Histomorphometry revealed a significantly larger neointimal area in stainless steel (2.61±1.12 mm²) than in TiNOX 1–coated (1.47±0.84 mm², P<0.02) or TiNOX 2–coated (1.39±0.93 mm², P<0.02) stents. The reductions were 44% and 47%, respectively.

Conclusions—— TiNOX coating significantly reduces neointimal hyperplasia in stainless steel stents. The antiproliferative effect was similar for both TiNOX coatings, suggesting that the electrochemical properties are more important for attenuation of neointimal proliferation than the observed differences in platelet adhesion and fibrinogen binding.

Key Words: stents • restenosis • titanium-nitride-oxide • hyperplasia

This article has been cited by other articles:

				H.-S. Shin, K. Park, Ji Heung Kim, J.-J. Kim, Dong Keun Han, M.-W. Moon, K.-R. Lee, and Ji Hoon Shin Biocompatible PEG Grafting on DLC-coated Nitinol Alloy for Vascular Stents Journal of Bioactive and Compatible Polymers, July 1, 2009; 24(4): 316 - 328. [Abstract] [PDF]

				F. Kantarci, I. Mihmanli, M. S. Albayram, H. Barutca, F. Gulsen, N. Kocer, and C. Islak Follow-up of extracranial vertebral artery stents with Doppler sonography. Am. J. Roentgenol., September 1, 2006; 187(3): 779 - 787. [Abstract] [Full Text] [PDF]

				S. Windecker, R. Simon, M. Lins, V. Klauss, F. R. Eberli, M. Roffi, G. Pedrazzini, T. Moccetti, P. Wenaweser, M. Togni, et al. Randomized Comparison of a Titanium-Nitride-Oxide-Coated Stent With a Stainless Steel Stent for Coronary Revascularization: The TiNOX Trial Circulation, May 24, 2005; 111(20): 2617 - 2622. [Abstract] [Full Text] [PDF]

				K. Schurmann, J. Lahann, P. Niggemann, B. Klosterhalfen, J. Meyer, A. Kulisch, D. Klee, R. W. Gunther, and D. Vorwerk Biologic Response to Polymer-coated Stents: In Vitro Analysis and Results in an Iliac Artery Sheep Model Radiology, January 1, 2004; 230(1): 151 - 162. [Abstract] [Full Text] [PDF]