title: Histopathological heterogeneity of in-stent restenosis in four coronary endarterectomy specimens.
abstract: Here, we histopathologically compare four patients undergoing coronary artery bypass with coronary endarterectomy and onlay patch grafting for in-stent restenosis (ISR) after the implantation of a bare-metal stent (BMS), sirolimus-eluting stent (SES), or paclitaxel-eluting stent (PES) in an everolimus-eluting stent (EES). Heterogeneity of ISR was noted histopathologically. In ISR for BMS, restenosis is likely caused by so-called neoatherosclerosis that occurred which altered the healing process of BMS implantation. Two ISR cases for SES showed a histopathological heterogeneity: one showed nodular calcified thrombus around stent strut protruding into the lumen, and the other showed concentric neointima composed of CD68-positive foam cell proliferation. In the ISR lesion for PES in EES, infiltrations with foam cells macrophages, particularly numerous eosinophilic cell infiltrations, suggest a peristent strut hypersensitivity reaction. We found a remarkable histopathological heterogeneity of ISR. The study using coronary endarterectomy specimens can give us pivotal information about the histopathological heterogeneity of ISR.
authors.affiliation: Department of Cardiovascular Medicine, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Takashima
authors.affiliation: Department of Cardiovascular Medicine, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan; Department of Cardio-Diabetes Medicine, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan. Electronic address: mshimabukuro-ur@umin.ac.jp.
authors.forename: Michio
authors.initials: M
authors.lastname: Shimabukuro
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Tabata
authors.affiliation: Department of Cardiovascular Medicine, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan; Department of Cardio-Diabetes Medicine, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
authors.forename: Daiju
authors.initials: D
authors.lastname: Fukuda
authors.affiliation: Department of Cardiovascular Medicine, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
authors.forename: Etsuko
authors.initials: E
authors.lastname: Uematsu
authors.affiliation: Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Hatsue
authors.initials: H
authors.lastname: Ishibashi-Ueda
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
authors.affiliation: Department of Cardiovascular Medicine, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Sata
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D023903:Coronary Restenosis / Q000473:pathology*; D054855:Drug-Eluting Stents; D004691:Endarterectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents
keywords: Coronary artery bypass; Coronary endarterectomy; In-stent restenosis; Percutaneous coronary intervention