ABC | Volume 111, Nº2, August 2018

Original Article Farsky et al Persistent inflammation after stent Arq Bras Cardiol. 2018; 111(2):134-141 1. Gaudino M, Cellini C, Pragliola C, Trani C, Burzotta F, Schiavoni G, et al. Arterial versus venous bypass grafts in patients with in-stent restenosis. Circulation. 2005;112(9 Suppl):I265-9. 2. Gomes WJ, Buffolo E. Coronary stenting and inflammation: implications for furthersurgicalandmedicaltreatment.AnnThoracSurg.2006;81(5):1918-25. 3. HassanA,ButhKJ,BaskettRJ,AliIS,MaitlandA,SullivanJA,etal.Theassociation between prior percutaneous coronary intervention and short-term outcomes after coronary artery bypass grafting. AmHeart J. 2005;150(5):1026-31. 4. Rao C, Stanbridge Rde L, Chikwe J, Pepper J, Skapinakis P, AzizO, et al. Does previous percutaneous coronary stenting compromise the long-termefficacy of subsequent coronary artery bypass surgery? Amicrosimulation study. Ann Thorac Surg. 2008;85(2):501-7. 5. Thielmann M, Leyh R, Massoudy P, Neuhäuser M, Aleksic I, Kamler M, et al. Prognostic significance of multiple previous percutaneous coronary interventions in patients undergoing elective coronary artery bypass surgery. Circulation. 2006;114(1 Suppl):I441-7. References Our finding indicated the presence of persistent systemic and local chronic inflammation in individuals with previous stent implantation and can probably contribute to the worst outcome described in a previous meta-analysis study. 7 It is known that persistent inflammatory response may result in several complications, such as atherosclerotic plaque formation in arterial vessels. In a substudy of the MASS II Trial, 9 consecutive angiographic results were compared with the progression of coronary artery atherosclerosis in medical treatment (MT), CABG and angioplasty. The authors have observed a greater progression in at least one native vessel in angioplasty patients than in CABG and MT patients, concluding that angioplasty treatment has the worst progression in native coronary arteries, especially in the left anterior descending territories. Our result also showed inflammation process in native arteries from individuals with previous stent implantation. Limitations This study was limited to BMS. We had very few DES with restenosis and CABG indication. Because of the tiny size of the samples, only a small number of adipose tissue samples was obtained in group A2. Unfortunately, because of the tiny size, many samples collected were inadequate for analysis, and some had insufficient material for analysis. It is worth mentioning that the surgeon primarily ensures the patient’s safety. The arterial sample was collected at the least affected segment, for best surgical results in graft implantation, distal to the stent, place of possible less inflammation and less affected by the stent. Restenosis is associated with a local and systemic inflammatory reaction that could be related to obstructive lesions in stented arteries. However, only nine patients were operated upon in less than 365 days, and the arterial samples were taken at least 10 mm after the stent implantation, which reduces its influence on the results. Statin, which has known anti-inflammatory activity, can influence partially on this result, but it was minimized because all patients were under this therapeutic procedure that has a class I indication. Conclusion In conclusion, the persistently higher systemic expression of TNF in association with the local exacerbated TNF-alpha and IL-6 production in coronary arteries with previous BMS implantation may contribute to worse clinical outcomes after CABG surgery. Author contributions Conception and design of the research: Farsky PS, Hirata MH, Lima PHO, Lin-Wang HT; Acquisition of data: Farsky PS, Arnoni RT, Almeida AFS, Issa M, Lima PHO, Higuchi ML, Lin-Wang HT; Analysis and interpretation of the data: Farsky PS, Hirata MH, Arnoni RT, Almeida AFS, Issa M, Lima PHO, Higuchi ML, Lin-Wang HT; Statistical analysis: Lin-Wang HT; Obtaining financing: Farsky PS, Lima PHO; Writing of the manuscript: Farsky PS, Lin-Wang HT; Critical revision of the manuscript for intellectual content: Farsky PS, Hirata MH, Arnoni RT, Almeida AFS, Issa M, Lin-Wang HT. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding This study was funded by FAPESP. Study Association This article is part of the thesis of Post-Doctoral submitted by Pedro Silvio Farsky, from Instituto Dante Pazzanese de Cardiologia / Universidade de São Paulo. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Instituto de Cardiologia Dante Pazzanese under the protocol number 4059-2011. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. 140