Pathological features of in-stent restenosis after sirolimus-eluting stent versus bare metal stent placement |
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| Authors: | Shichiro Abe Shuichi Yoneda Tomoaki Kanaya Kazuhiko Oda Setsu Nishino Michiya Kageyama Isao Taguchi Nobuhide Masawa Teruo Inoue |
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| Affiliation: | 1. Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan;2. Department of Pathology, Dokkyo Medical University, Mibu, Tochigi, Japan;1. Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, NY, USA;2. Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University Medical Center, NY, USA;3. Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, NY, USA;4. Department of Neurology, Icahn School of Medicine at Mount Sinai, NY, USA;1. Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan;2. Department of Genome Research and Clinical Investigation, Chiba University Graduate School of Medicine, Chiba, Japan;1. Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan;2. Department of Laboratory Medicine, School of Medicine, Keio University, Tokyo, Japan;3. Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan;4. Department of Cardiology, First Internal Medicine, National Defense Medical College, Saitama, Japan;5. Department of Physiology, Tokai University School of Medicine, Kanagawa, Japan |
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| 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. |
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