title: Pathological features of in-stent restenosis after sirolimus-eluting stent versus bare metal stent placement.
abstract: A 70-year-old man developed diffuse restenosis in the right coronary artery, in which a bare metal stent (BMS) and two sirolimus-eluting stents (SES) were deployed sequentially. He underwent directional coronary atherectomy (DCA) for in-stent restenosis (ISR) lesions 13 months after both BMS and SES stenting. Further 4 months later, that is, 17 months after stent implantation, however, ISR recurred just at the SES site alone. Then we performed second DCA for the ISR lesion at SES site. The tissue materials obtained from debulking were compared histologically. In the first DCA specimen, accumulation of inflammatory cells such as T lymphocytes and macrophages was observed densely in ISR lesions at SES site but not in those at BMS site, and endothelial coverage was absent in ISR lesions at SES site but present in those at BMS site. In the second DCA specimen, ISR lesions at SES site showed less inflammatory cells, compared with first DCA specimen. ISR lesions after drug-eluting stenting showed persistent signs of delayed or incomplete wound healing and relapsed inflammation, compared with BMS. Thus, the mechanism of restenosis after drug-eluting stenting may be different from that after BMS placement.
authors.affiliation: Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan. abenana@dokkyomed.ac.jp
authors.forename: Shichiro
authors.initials: S
authors.lastname: Abe
authors.forename: Shuichi
authors.initials: S
authors.lastname: Yoneda
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kanaya
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Oda
authors.forename: Setsu
authors.initials: S
authors.lastname: Nishino
authors.forename: Michiya
authors.initials: M
authors.lastname: Kageyama
authors.forename: Isao
authors.initials: I
authors.lastname: Taguchi
authors.forename: Nobuhide
authors.initials: N
authors.lastname: Masawa
authors.forename: Teruo
authors.initials: T
authors.lastname: Inoue
mesh_terms: D000368:Aged; D017225:Atherectomy, Coronary / Q000379:methods*; D015415:Biomarkers / Q000378:metabolism; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D003331:Coronary Vessels / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008297:Male; D032389:Myocytes, Smooth Muscle / Q000378:metabolism / Q000473:pathology; D019007:P-Selectin / Q000378:metabolism; D011474:Prosthesis Design; D011475:Prosthesis Failure; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents / Q000009:adverse effects*; D014945:Wound Healing; D014841:von Willebrand Factor / Q000378:metabolism
chemical_list: D015415:Biomarkers; D019007:P-Selectin; D014841:von Willebrand Factor; D020123:Sirolimus