Inflammatory Mechanisms of Adverse Reactions to BMS

Adverse reactions to bare metal stent implantation include stent thrombosis and restenosis. Although thrombosis in bare metal stents seems mainly to be affected by procedural factors, restenosis is a more complex procedure involving mechanisms of tissue repair after vessel injury occurring during implantation. This procedure includes early platelet and leukocyte invasion, followed by smooth muscle cell proliferation, as well as further inflammatory cell recruitment mediated by expression of chemokines and leukocyte activation at the site of the injury. In this report, we will focus on the role of inflammation in the development of in-stent restenosis in bare metal stents. In particular, we will describe the pathologic evidence implicating inflammatory cell involvement in the development of restenosis in animal and human models; we will analyze the molecular mechanisms linking inflammation with restenosis; and will review the association of pre-existing or procedure-induced systemic inflammation with adverse reactions at follow-up.