BACKGROUND: Polymer coatings have been used to modify the surface of stents and to serve as a matrix for local drug delivery. METHODS: Bare stainless steel stents or poly-bis-trifluorethoxy phosphazene (PTFEP) dip-coated stents (Coroflex, Germany) were randomly implanted into porcine coronary arteries with a balloon-to-artery ratio of 1.1-1.2 : 1. Scanning electron microscopy (SEM), repeat quantitative coronary angiography (QCA) and histomorphometric analysis were performed at 5 days, 6 weeks and 6 months. RESULTS: At 5 days, complete endothelial cell coverage with fibrin strands was detected in both the bare and the coated stents with SEM. Late loss, determined by QCA, of coated and bare stents was identical at all time points. Histomorphometric analysis showed that coated and bare stents elicited a similar tissue response at 5 days. At 6 weeks, the coated stents showed a moderate peri-strut inflammatory response, resulting in increased neointimal hyperplasia. Compared to the bare stents, however, no significant differences were observed. At 6 months, peri-strut inflammation was minimal and similar in the coated and the bare stent groups. Neointimal hyperplasia of the coated and bare stent groups was also comparable (1.37+/-0.44 compared with 1.15+/-0.40 mm2, P=0.213) and decreased compared to the 6-week response. CONCLUSION: This PTFEP stent coating showed a long-term biocompatibility in a porcine coronary stent model. Because no increased proliferative response was observed up to 6 months, this phosphazene coating may serve as a vehicle for local drug delivery.