Pathological finding of sirolimus-eluting stent (SES) restenosis lesion with black hole appearance on intravascular ultrasound.
Restenosis still occurs, even with the sirolimus-eluting stent (SES), and the precise mechanisms have not yet been elucidated. In the present case, focal in-stent stenosis was discovered on angiography 16 months after SES implantation. Intravascular ultrasound revealed an echolucent homogeneous zone, which has been termed "black hole". A sample of stenotic tissue retrieved by aspiration revealed neointimal hyperplasia, composed of proteoglycans and smooth muscle cells with scanty cellularity. Furthermore, infiltration of many macrophages and T lymphocytes coexisted in the restenotic tissue. These findings suggest that delayed healing is 1 of the mechanisms of SES restenosis.
Goto
Kenji
K
Department of Cardiology, Matsue Red Cross Hospital, Japan. kenji-g@go4.enjoy.ne.jp
Shiode
Nobuo
N
Shirota
Kinya
K
Fukuda
Yukihiro
Y
Kitamura
Fumiyo
F
Tominaga
Koichi
K
Kato
Yasuko
Y
Miura
Hiroshi
H
Inoue
Katsumi
K
Nobuyoshi
Masakiyo
M
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation*; D001707:Biopsy, Needle; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D054855:Drug-Eluting Stents; D006801:Humans; D006965:Hyperplasia; D008264:Macrophages / Q000473:pathology; D008297:Male; D020123:Sirolimus / Q000008:administration & dosage*; D013601:T-Lymphocytes / Q000473:pathology; D017539:Tunica Intima / Q000473:pathology; D018084:Ultrasonography, Interventional
D002317:Cardiovascular Agents; D020123:Sirolimus