Variable histological and ultrasonic characteristics of restenosis after drug-eluting stents.
Bare-metal stents have undergone intense pathological and clinical examination, but histological characterization of drug-eluting stent (DES) restenosis (ISR) remains unknown. We report a series of cases (n=6) with intravascular ultrasound (IVUS) and pathological examinations over 8 months after DES deployment. Tissue samples were obtained using atherectomy devices in 5 cases and a thrombectomy catheter in 1 case. Histology revealed not only smooth muscle cell proliferation, which correlated with homogeneous hypoechoic tissue by IVUS in one case, but also demonstrated delayed healing features such as organized fibrin deposition in 3 cases (one with homogeneous echolucent tissue by IVUS), macrophage and T-lymphocyte infiltration in others. IVUS appearance of ISR components varied from echolucent to echodense images. This report suggests a variable histological and IVUS pattern of ISR after DES implantation. Further investigations are necessary to define the potentially pro-thrombotic histological features of ISR after DES implantation, and the relationship between the molecular mechanisms of thrombosis and DES restenosis.
Suzuki
Nobuaki
N
Heart and Vascular Institute, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, USA.
Angiolillo
Dominick J
DJ
Monteiro
Carmela
C
Shuja
Sania
S
Futamatsu
Hideki
H
Kawaguchi
Ren
R
Box
Lyndon C
LC
Guzman
Luis
L
Zenni
Martin M
MM
Gilmore
Paul S
PS
Bass
Theodore A
TA
Costa
Marco A
MA
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017073:Atherectomy; D003327:Coronary Disease / Q000473:pathology / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D054855:Drug-Eluting Stents; D005260:Female; D005337:Fibrin / Q000378:metabolism; D006801:Humans; D008264:Macrophages / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009131:Muscle, Smooth, Vascular / Q000473:pathology; D013601:T-Lymphocytes / Q000473:pathology; D017131:Thrombectomy; D018084:Ultrasonography, Interventional
D005337:Fibrin