Porcine Coronary Restenosis Model Research Articles

Preliminary Investigation on Efficacy and Safety of Substance P-Coated Stent for Promoting Re-Endothelialization: A Porcine Coronary Artery Restenosis Model.

Current polymer-based drug-eluting stents (DESs) have fundamental issues about inflammation and delayed re-endothelializaton of the vessel wall. Substance-P (SP), which plays an important role in inflammation and endothelial cells, has not yet been applied to coronary stents. Therefore, this study compares poly lactic-co-glycolic acid (PLGA)-based everolimus-eluting stents (PLGA-EESs) versus 2-methacryloyloxyethyl phosphorylcholine (MPC)-based SP-eluting stents (MPC-SPs) in in-vitro and in-vivo models. The morphology of the stent surface and peptide/drug release kinetics from stents were evaluated. The in-vitro proliferative effect of SP released from MPC-SP is evaluated using human umbilical vein endothelial cell. Finally, the safety and efficacy of the stent are evaluated after inserting it into a pig's coronary artery. Similar to PLGA-EES, MPC-SP had a uniform surface morphology with very thin coating layer thickness (2.074μm). MPC-SP showed sustained drug release of SP for over 2weeks. Endothelial cell proliferation was significantly increased in groups treated with SP (n = 3) compared with the control (n = 3) and those with everolimus (n = 3) (SP: 118.9 ± 7.61% vs. everolimus: 64.3 ± 12.37% vs. the control: 100 ± 6.64%, p < 0.05). In the animal study, the percent stenosis was higher in MPC-SP group (n = 7) compared to PLGA-EES group (n = 7) (MPC-SP: 28.6 ± 10.7% vs. PLGA-EES: 16.7 ± 6.3%, p < 0.05). MPC-SP group showed, however, lower inflammation (MPC-SP: 0.3 ± 0.26 vs. PLGA-EES: 1.2 ± 0.48, p < 0.05) and fibrin deposition (MPC-SP: 1.0 ± 0.73 vs. PLGA-EES: 1.5 ± 0.59, p < 0.05) around the stent strut. MPC-SP showed more increased expression of cluster of differentiation 31, suggesting enhanced re-endothelialization. Compared to PLGA-EES, MPC-SP demonstrated more decreased inflammation of the vascular wall and enhanced re-endothelialization and stent coverage. Hence, MPC-SP has the potential therapeutic benefits for the treatment of coronary artery disease by solving limitations of currently available DESs.

Vascular Response Study of Novel Material Biodegradable-Polymer Scaffolds in the Porcine Coronary Restenosis Model: Insights Into Development of New Bioresorbable Scaffolds

Vascular Response Study of Novel Material Biodegradable-Polymer Scaffolds in the Porcine Coronary Restenosis Model: Insights Into Development of New Bioresorbable Scaffolds

Effect of Novel Polymer-Free Nitrogen-Doped Titanium Dioxide Film-Coated Coronary Stent Loaded With Mycophenolic Acid.

Background: Titanium is commonly used in blood-exposed medical devices because it has superior blood compatibility. Mycophenolic acid inhibits the proliferation of vascular smooth muscle cells. This study examined the effect of a non-polymer TiO2 thin film–coated stent with mycophenolic acid in a porcine coronary overstretch restenosis model. Methods: Thirty coronary arteries in 15 pigs were randomized into three groups in which the coronary arteries were treated with a TiO2 film–coated stent with mycophenolic acid (NTM, n = 10), everolimus-eluting stent with biodegradable polymer (EES, n = 10), or TiO2 film–coated stent (NT, n = 10). A histopathologic analysis was performed 28 days after the stenting. Results: There were no significant intergroup differences in injury score, internal elastic lamina area, or inflammation score. Percent area stenosis was significantly smaller in the NTM and EES groups than in the NT group (36.1 ± 13.63% vs. 31.6 ± 7.74% vs. 45.5 ± 18.96%, respectively, p = 0.0003). Fibrin score was greater in the EES group than in the NTM and NT groups [2.0 (range, 2.0–2.0) vs. 1.0 (range, 1.0–1.75) vs. 1.0 (range, 1.0–1.0), respectively, p < 0.0001]. The in-stent occlusion rate measured by micro-computed tomography demonstrated similar percent area stenosis rates on histology analysis (36.1 ± 15.10% in NTM vs. 31.6 ± 8.89% in EES vs. 45.5 ± 17.26% in NT, p < 0.05). Conclusion: The NTM more effectively reduced neointima proliferation than the NT. Moreover, the inhibitory effect of NTM on smooth muscle cell proliferation was not inferior to that of the polymer-based EES with lower fibrin deposition in this porcine coronary restenosis model.

PRECLINICAL EVALUATION OF THE VASCULAR EFFECTS OF REJUVENATE® COBALT CHROMIUM CORONARY STENT SYSTEM IMPLANTED IN THE PORCINE CORONARY IN STENT RESTENOSIS MODEL

Objectives: The main objective of the study was to evaluate the implantation, safety, and vascular tissue effects of REJUVENATE® Cobalt Chromium Bare Metal Stent in the Porcine Coronary Restenosis model at short, mid and long-term follow up.&#x0D; Methodology: A total of 18 REJUVENATE® bare metal stents (CoCr, 95 µm strut thickness) were implanted into the coronary arteries (RCA, LCX and LAD) of the six pigs. Throughout the study period, stent patency, vascular response, percent stenosis, late lumen loss and performance of stent were evaluated by angiography, optical coherence tomography (OCT), and Histopathology (includes both Histopathology and histomorphometry) at 30, 90, and 180 days and compared with the results of control Bare Metal Stent Coflexus®. The mean, variance and standard deviation was analyzed using SPSS software.&#x0D; Results: OCT and QCA analysis demonstrated two cases of binary restenosis at 30 days follow-up and two at 90 days follow-up (33%). The mean area stenosed for Rejuvenate® was 34% as compared to 24% of Coflexus® and at 180 days follow up, it decreased to 21%. The histopathology analysis demonstrated favorable safety with acceptable levels of neointimal formation, with decreased levels of inflammation and complete endothelialization in 180 days.&#x0D; Conclusion: This study proved the potential safety of REJUVENATE® in porcine model and supports that this stent can move forward for the human trials.

Effect of dyslipidemia on vascular smooth muscle cell proliferation in a porcine coronary restenosis model

Effect of dyslipidemia on vascular smooth muscle cell proliferation in a porcine coronary restenosis model

Novel Polymer-Free Everolimus-Eluting Stent Fabricated using Femtosecond Laser Improves Re-endothelialization and Anti-inflammation

The aim of this study was to fabricate a novel polymer-free everolimus-eluting stent with nanostructure using a femtosecond laser (FSL). The stent were coated with everolimus (EVL) using FSL and electrospinning processes. The surface was rendered hydrophobic, which negatively affected both platelet adhesion (82.1%) and smooth muscle cell response. Animal study was performed using a porcine coronary restenosis model. The study groups were divided into 1) bare metal stent (BMS), 2) poly(L-lactide) (PLA)-based EVL drug eluting stent (DES), 3) commercial EVL-eluting DES, and 4) FSL-EVL-DES. After four weeks of stent implantation, various analyses were performed. Quantitative analysis showed that the amount of in-stent restenosis was higher in the BMS group (BMS; 27.8 ± 2.68%, PLA-based DES; 12.2 ± 0.57%, commercial DES; 9.8 ± 0.28%, and FSL-DES; 9.3 ± 0.25%, n = 10, p < 0.05). Specifically, the inflammation score was reduced in the FSL-DES group (1.9 ± 0.39, n = 10, p < 0.05). The increment in re-endothelialization in the FSL-DES group was confirmed by immunofluorescence analysis. Taken together, the novel polymer-free EVL-eluting stent fabricated using FSL can be an innovative DES with reduced risk of ISR, thrombosis, and inflammation.

Anti-Inflammatory Effect of Gallic Acid-Eluting Stent in a Porcine Coronary Restenosis Model.

Gallic acid (3,4,5-trihydroxybenzoic acid) is a natural polyphenol and strong natural antioxidant found abundantly in red wine and green tea. The aim of this study was to examine the anti-inflammatory effect of a novel gallic acid-eluting stent in a porcine coronary restenosis model. Fifteen pigs were randomized into three groups; in which a total of 30 coronary arteries (10 in each group) were implanted with gallic acid-eluting stents (GESs, n = 10), gallic acid and sirolimus-eluting stents (GSESs, n = 10), or sirolimus-eluting stents (SESs, n = 10). Histopathologic analysis was performed 28 days after stenting. There were no significant differences in injury score and fibrin score among the groups, however there were significant differences in the internal elastic lamina (4.0 ± 0.83 mm2 in GES vs. 3.0 ± 0.53 mm2 in GSES vs. 4.6 ± 1.43 mm2 in SES, p < 0.0001), lumen area (2.3 ± 0.49 mm2 in GES vs. 1.9 ± 0.67 mm2 in GSES vs. 2.9 ± 0.56 mm2 in SES, p < 0.0001), neointimal area (1.7 ± 0.63 mm2 in GES vs. 1.1 ± 0.28 mm2 in GSES vs. 1.7 ± 1.17 mm2 in SES, p < 0.05), and percent area of stenosis (42.4% ± 9.22% in GES vs. 38.2% ± 12.77% in GSES vs. 33.9% ± 15.64% in SES, p < 0.05). The inflammation score was significantly lower in the GES and GSES groups compared to that in the SES group [1.0 (range: 1.0 to 2.0) in GES vs. 1.0 (range: 1.0 to 1.0) in GSES vs. 1.5 (range: 1.0 to 3.0) in SES, p < 0.05]. The GES group had a greater percent area of stenosis than the SES group. Although gallic acid in the GES and GSES groups did not show a synergistic effect in suppressing neointimal hyperplasia, it resulted in greater inhibition of the inflammatory reaction in the porcine coronary restenosis model than in the SES group.

Effect of a Non-polymer Titanium Dioxide Thin Film-Coated Stent with Heparin in a Porcine Coronary Restenosis Model

Purpose The aim of this study was to examine the effect of non-polymer titanium dioxide (TiO2) thin film-coated stents modified with heparin in a porcine coronary overstretch restenosis model. Methods Pigs were randomized into three groups in which either TiO2 film-heparin coated stent (THS, n=12), zotarolimus-eluting stent with polymer (ZES, n=12), or bare metal stent (BMS, n=12) was placed in a coronary artery (18 pigs, 12 coronaries in each group). Histopathologic analysis was performed at 28 days after stenting. Results There was no significant difference in injury score among the three groups. There were significant differences in neointima area (2.9±0.85 mm2 in the THS group vs. 2.8±0.10 mm2 in the ZES group vs. 3.3±0.58 mm2 in the BMS group, P<0.05), fibrin score (0.0 [range 0.0 to 1.0] in the THS group vs. 2.0 [range 2.0 to 2.0] in the ZES group vs. 0.5 [range 0.0 to 2.0] in the BMS group, P<0.0001), and inflammation score (1.0 [range 0.0-1.0] in the THS group vs. 1.0 [range 1.0 to 2.0] in the ZES group vs. 1.0 [range 0.75 to 1.0] in the BMS group, P<0.0001) among the three groups. In-stent restenosis rate, as measured by micro computed tomography, demonstrated similar percent area values upon histology analysis (57.7±13.14% in the THS group vs. 58.7±16.44% in the ZES group 64.8±8.56% in the BMS group, P<0.05). Conclusion THS is more effective in reducing neointima formation compared to BMS. Moreover, the neointima suppressive effect of THS exceeds that of commercial ZES, with lower fibrin and inflammation scores in a porcine coronary restenosis model. Keywords: Stents, Percutaneous coronary intervention, Restenosis, Inflammation

TCT-488 Determinants of stent healing in optical coherence tomography. Validation study with histopathology in the porcine coronary restenosis model

TCT-488 Determinants of stent healing in optical coherence tomography. Validation study with histopathology in the porcine coronary restenosis model

Long-term preclinical evaluation of bioabsorbable polymer-coated drug-eluting stent in a porcine model

Bioabsorbable polymer-based drug-eluting stents have been shown to be effective and safe in the actual practice. The objective of the present study was to evaluate a biodegradable poly-L-lactic acid (PLLA)-based sirolimus-coated stent in comparison with a commercial everolimus-eluting stent with a permanent polymer in a porcine coronary restenosis model on a short-, mid-, and long-term basis. Pigs were randomized into eight groups in which the coronary arteries (36 pigs with 72 coronary arteries) had either a sirolimus-eluting stent with PLLA (SES, n=24, follow-up after 4, 12, and 24 weeks), bare metal stent (BMS, n=12, follow-up after 4 weeks), PLLA-coated stent without a drug (PCS, n=12, follow-up after 4 weeks), or commercial everolimus-eluting stent with a permanent polymer (EES, Promus PREMIER®, n=24, follow-up after 4, 12, and 24 weeks). Histopathological analysis was performed at 4, 12, or 24 weeks after stenting. The surface morphology of the SES, visualized using an optical microscope and a scanning electron microscope, was smooth and uniform with virtually no defects. Sirolimus was released slowly over 60 days. There was no significant difference in the percent area stenosis between the SES and EES at any of the follow-up time points (13.0±8.10% in SES vs. 14.1±9.12% in EES at 4 weeks, 23.1±8.63% in SES vs. 21.3±7.92% in EES at 12 weeks, 28.2±8.20% in SES vs. 25.1±8.51% in EES at 24 weeks, each p=NS). The percent area stenosis using micro-computed tomography and intravenous ultrasound demonstrated similar restenosis rates with histopathological stenosis between the SES and EES. The SES with a biodegradable polymer was as effective as the commercial EES with a permanent polymer in inhibiting neointima proliferation at 4, 12, and 24 weeks in a porcine coronary restenosis model.

Effects of ticagrelor on neointimal hyperplasia and endothelial function, compared with clopidogrel and prasugrel, in a porcine coronary stent restenosis model

BackgroundSeveral investigations have been conducted to evaluate the off-target effects of ticagrelor. The aim of the present study was to evaluate the off-target effects of ticagrelor such as neointimal formation and endothelial function after drug-eluting stent implantation in a porcine restenosis model. MethodsA total of 30 pigs were randomly allocated based on the following P2Y12 inhibitor: (1) clopidogrel 300mg loading plus 75mg maintenance (n=10); (2) prasugrel 60mg loading plus 10mg maintenance (n=10); (3) ticagrelor 180mg loading plus 180mg maintenance (n=10). In each group, zotarolimus-eluting stents were implanted in the proximal portion of the left anterior descending artery and left circumflex artery. One month after stenting, the animals underwent follow-up angiography, endothelial function assessment, optical coherence tomography (OCT) and histopathological analysis. ResultsRegarding vasomotor responses to acetylcholine infusion, there were significant vasoconstrictions to maximal acetylcholine infusion in the clopidogrel and prasugrel group compared with those in the ticagrelor group. The mean neointimal area were significantly lower in the ticagrelor group (1.0±0.3 by OCT, 0.9±0.3 by histology), than in the clopidogrel (1.8±0.7, p=0.003, 1.6±0.8, p=0.030) and prasugrel (1.8±0.5, p=0.001, 1.5±0.5, p=0.019) groups. Percentages of moderate to dense peri-strut inflammatory cell infiltration were significantly lower in the ticagrelor group (9.0%) compared with the clopidogrel (17.3%, p<0.001) and prasugrel groups (15.7%, p=0.002). There were no significant differences in all findings between clopidogrel and prasugrel groups. ConclusionsCompared to clopidogrel and prasugrel, ticagrelor reduced neointimal formation, endothelial dysfunction, and peri-strut inflammation.

TCTAP A-052 Effects of Ticagrelor on Neointimal Hyperplasia and Endothelial Function, Compared with Clopidogrel and Prasugrel, in a Porcine Coronary Stent Restenosis Model

TCTAP A-052 Effects of Ticagrelor on Neointimal Hyperplasia and Endothelial Function, Compared with Clopidogrel and Prasugrel, in a Porcine Coronary Stent Restenosis Model

Effect of Stents Coated with Artemisinin or Dihydroartemisinin in a Porcine Coronary Restenosis Model.

Background and ObjectivesArtemisinin and dihydroartemisinin are drugs used to treat malaria. These drugs suppress inflammatory reactions. The aim of this study was to examine the anti-intima hyperplasia effect of a novel drug-eluting stent with artemisinin or dihydroartemisinin in a porcine coronary restenosis model.Materials and MethodsPigs were randomized into four groups; in the first, the coronary arteries (20 pigs, a total of 40 coronary arteries, with 10 coronary arteries in each group) was implanted with bare metal stents (BMS, n=10); the second group was given polymer-coated stents (PCS, n=10); the third group was treated with artemisinin-eluting stents (AES, n=10); and the fourth group was given dihydroartemisinin-eluting stents (DAES, n=10). Histopathologic analysis was performed 28 days after stenting.ResultsThe injury and fibrin scores among the four groups were not significantly different. However, the internal elastic lamina, lumen area, and neointima area were significantly different. Moreover, the percent area of stenosis (46.2±18.66% in BMS vs. 89.4±10.92% in PCS vs. 83.3±17.07% in AES vs. 36.7±11.20% in DAES, p<0.0001) and inflammation score (1.0 [range: 1.0-1.0] vs. 3.0 [range: 2.25-3.0] vs. 3.0 [range: 1.0-3.0] vs. 2.0 [range: 1.75-3.0] in BMS, PCS, AES, and DAES, respectively; p<0.001) were markedly decreased in the DAES group compared to the PCS group.ConclusionDES, which uses a natural substance, dihydroartemisinin, showed a neointima and inflammatory suppressive effect in a porcine coronary restenosis model.

The Control of Drug Release and Vascular Endothelialization after Hyaluronic Acid-Coated Paclitaxel Multi-Layer Coating Stent Implantation in Porcine Coronary Restenosis Model.

Background and ObjectivesHyaluronic acid (HA) is highly biocompatible with cells and the extracellular matrix. In contrast to degradation products of a synthetic polymer, degradation products of HA do not acidify the local environment. The aim of this study was to fabricate an HA-coated paclitaxel (PTX)-eluting stent via simple ionic interactions and to evaluate its effects in vitro and in vivo.Materials and MethodsHA and catechol were conjugated by means of an activation agent, and then the stent was immersed in this solution (resulting in a HA-coated stent). After that, PTX was immobilized on the HA-coated stent (resulting in a hyaluronic acid-coated paclitaxel-eluting stent [H-PTX stent]). Study groups were divided into 4 groups: bare metal stent (BMS), HA, H-PTX, and poly (L-lactide)-coated paclitaxel-eluting stent (P-PTX). Stents were randomly implanted in a porcine coronary artery. After 4 weeks, vessels surrounding the stents were isolated and subjected to various analyses.ResultsSmoothness of the surface was maintained after expansion of the stent. In contrast to a previous study on a PTX-eluting stent, in this study, the PTX was effectively released up to 14 days (a half amount of PTX in 4 days). The proliferation of smooth muscle cells was successfully inhibited (by 80.5±12.11% at 7 days of culture as compared to the control) by PTX released from the stent. Animal experiments showed that the H-PTX stent does not induce an obvious inflammatory response. Nevertheless, restenosis was clearly decreased in the H-PTX stent group (9.8±3.25%) compared to the bare-metal stent group (29.7±8.11%).ConclusionA stent was stably coated with PTX via simple ionic interactions with HA. Restenosis was decreased in the H-PTX group. These results suggest that HA, a natural polymer, is suitable for fabrication of drug-eluting stents (without inflammation) as an alternative to a synthetic polymer.

TCT-837 Comparable vascular response of a new generation sirolimus eluting stents when compared to fluoropolymer everolimus eluting stents in the porcine coronary restenosis model

TCT-837 Comparable vascular response of a new generation sirolimus eluting stents when compared to fluoropolymer everolimus eluting stents in the porcine coronary restenosis model

Optimal coating method for a dual-layer stent with sirolimus and alpha-lipoic acid in a porcine coronary restenosis model

The aim of this study was to evaluate the optimal method for coating a double-layer polymer coronary stent with sirolimus and alpha-lipoic acid (ALA) in a porcine coronary overstretch restenosis model. Pigs were randomized into three groups, in which the coronary arteries (10 in each group) were stented with a dual-layer stent with an inner layer of ALA and an outer layer of sirolimus (IAOS, n=10), a dual-layer stent with an inner layer of sirolimus and an outer layer of ALA (ISOA, n=10), or a commercial drug-eluting stent (biolimus-eluting stent, BES, n=10). Histopathological analysis was performed 28 days after stenting. There were no significant differences among the three groups in injury and inflammation scores. There were significant differences among the three groups in neointimal area (1.1±0.16 mm2 for IAOS vs. 1.3±0.41 mm2 for ISOA vs. 1.9±0.50 mm2 for BES, p<0.0001), and percentage of stenosis area (21.4±3.08% for IAOS vs. 29.9±7.72% for ISOA vs. 38.2±9.08% for BES, p<0.0001). Regarding the percentage of stenosis area, microcomputed tomography revealed significant differences between the three groups (23.8±3.51% for IAOS vs. 28.9±4.65% for ISOA vs. 36.4±8.07% for BES, p<0.05). Compared with commercial stent placement, both IAOS and ISOA resulted in significant inhibition of neointimal formation in a porcine coronary restenosis model. In addition, IAOS was more effective than ISOA in preventing anti-neointimal hyperplasia after stenting.

A novel polymer-free drug-eluting stent coated with everolimus using nitrogen-doped titanium dioxide film deposition in a porcine coronary restenosis model

BackgroundTitanium dioxide (TiO2) films have superior biocompatibility and may be effective as drug-binding matrices for drug-eluting stents (DESs). We sought to evaluate efficacy of a polymer-free DES coated with everolimus using nitrogen-doped TiO2 film deposition in a porcine coronary restenosis model. MethodsForty coronary arteries in 20 pigs were randomly allocated to group 1 (bare-metal stents (BMSs), 3.0×18mm, n=10), group 2 (BMSs with nitrogen-doped TiO2 film deposition, 3.0×18mm, n=10), group 3 [commercial everolimus-eluting stent, 3.0×18mm, n=10], and group 4 (polymer-free everolimus-eluting stent using nitrogen-doped TiO2 film deposition, 3.0×18mm, n=10). Stents were randomly implanted in the left anterior descending coronary artery and left circumflex artery with stent:artery ratio of 1.3. Four weeks later, pigs underwent follow-up coronary angiography and were sacrificed for histopathologic analysis. ResultsPercent area stenosis was greater in group 1 compared to groups 3 and 4 (46.4±13.8% vs. 30.2±11.7% vs. 29.2±8.9%, respectively, p=0.005). Fibrin score was lower in groups 1 and 2, compared to groups 3 and 4: 0.87±0.67 vs. 0.76±0.61 vs. 2.27±0.24 vs. 1.75±0.31, respectively, p<0.001). Injury score and inflammation score were not different. Comparison between DES showed a higher fibrin score in group 3 than group 4 (2.27±0.24 vs. 1.75±0.31, p=0.023). ConclusionsIn a porcine model of coronary restenosis, a novel polymer-free DES using nitrogen-doped TiO2 film deposition shows higher biocompatibility and compares favorably with a commercial DES.

TCTAP A-041 Effect of Polymer-Free Drug-Eluting Stent Coated with Everolimus Using Nitrogen-Doped TiO2 Film Deposition in a Porcine Coronary Restenosis Model

TCTAP A-041 Effect of Polymer-Free Drug-Eluting Stent Coated with Everolimus Using Nitrogen-Doped TiO2 Film Deposition in a Porcine Coronary Restenosis Model

EFFECT OF NON-POLYMER TITANIUM DIOXIDE THIN FILM COATED STENT WITH HEPARIN IN PORCINE CORONARY RESTENOSIS MODEL

Drug-eluting stents (DES) without polymer may overcome the defects of DES using polymer. The aim of this study was to examine the effect of the non-polymer titatanium dioxide (TiO2) thin film-coated stent with heparin in a porcine coronary overstretch restenosis model. Pigs were randomized into

Effect of stents coated with a combination of sirolimus and alpha-lipoic acid in a porcine coronary restenosis model

The aim of this study was to evaluate antiproliferative sirolimus- and antioxidative alpha-lipoic acid (ALA)-eluting stents using biodegradable polymer [poly-L-lactic acid (PLA)] in a porcine coronary overstretch restenosis model. Forty coronary arteries of 20 pigs were randomized into four groups in which the coronary arteries had a bare metal stent (BMS, n = 10), ALA-eluting stent with PLA (AES, n = 10), sirolimus-eluting stent with PLA (SES, n = 10), or sirolimus- and ALA-eluting stent with PLA (SAS, n = 10). A histopathological analysis was performed 28 days after the stenting. The ALA and sirolimus released slowly over 30 days. There were no significant differences between groups in the injury or inflammation score; however, there were significant differences in the percent area of stenosis (56.2 ± 11.78% in BMS vs. 51.5 ± 12.20% in AES vs. 34.7 ± 7.23% in SES vs. 28.7 ± 7.30% in SAS, P < 0.0001) and fibrin score [1.0 (range 1.0-1.0) in BMS vs. 1.0 (range 1.0-1.0) in AES vs. 2.0 (range 2.0-2.0) in SES vs. 2.0 (range 2.0-2.0) in SAS, P < 0.0001] between the four groups. The percent area of stenosis based on micro-computed tomography corresponded with the restenosis rates based on histopathological stenosis in different proportions in the four groups (54.8 ± 7.88% in BMS vs. 50.4 ± 14.87% in AES vs. 34.5 ± 7.22% in SES vs. 28.9 ± 7.22% in SAS, P < 0.05). SAS showed a better neointimal inhibitory effect than BMS, AES, and SES at 1 month after stenting in a porcine coronary restenosis model. Therefore, SAS with PLA can be a useful drug combination for coronary stent coating to suppress neointimal hyperplasia.