Sirolimus-Eluting Stent Implanted in Human Coronary Artery for 16 Months
2003; Lippincott Williams & Wilkins; Volume: 107; Issue: 9 Linguagem: Inglês
10.1161/01.cir.0000062700.42060.6f
ISSN1524-4539
AutoresGiulio Guagliumi, Andrew Farb, Giuseppe Musumeci, Orazio Valsecchi, Maurizio Tespili, Teresio Motta, Renu Virmani,
Tópico(s)Electrodeposition and Electroless Coatings
ResumoHomeCirculationVol. 107, No. 9Sirolimus-Eluting Stent Implanted in Human Coronary Artery for 16 Months Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUBSirolimus-Eluting Stent Implanted in Human Coronary Artery for 16 MonthsPathological Findings Giulio Guagliumi, MD, Andrew Farb, MD, Giuseppe Musumeci, MD, Orazio Valsecchi, MD, Maurizio Tespili, MD, Teresio Motta, MD and Renu Virmani, MD Giulio GuagliumiGiulio Guagliumi From the Cardiovascular (G.G., G.M., O.V., M.T.) and Pathology Departments (T.M.), Ospedali Riuniti di Bergamo, Bergamo, Italy, and the Department of Cardiovascular Pathology (R.V., A.F.), Armed Forces Institute of Pathology, Washington, DC. , Andrew FarbAndrew Farb From the Cardiovascular (G.G., G.M., O.V., M.T.) and Pathology Departments (T.M.), Ospedali Riuniti di Bergamo, Bergamo, Italy, and the Department of Cardiovascular Pathology (R.V., A.F.), Armed Forces Institute of Pathology, Washington, DC. , Giuseppe MusumeciGiuseppe Musumeci From the Cardiovascular (G.G., G.M., O.V., M.T.) and Pathology Departments (T.M.), Ospedali Riuniti di Bergamo, Bergamo, Italy, and the Department of Cardiovascular Pathology (R.V., A.F.), Armed Forces Institute of Pathology, Washington, DC. , Orazio ValsecchiOrazio Valsecchi From the Cardiovascular (G.G., G.M., O.V., M.T.) and Pathology Departments (T.M.), Ospedali Riuniti di Bergamo, Bergamo, Italy, and the Department of Cardiovascular Pathology (R.V., A.F.), Armed Forces Institute of Pathology, Washington, DC. , Maurizio TespiliMaurizio Tespili From the Cardiovascular (G.G., G.M., O.V., M.T.) and Pathology Departments (T.M.), Ospedali Riuniti di Bergamo, Bergamo, Italy, and the Department of Cardiovascular Pathology (R.V., A.F.), Armed Forces Institute of Pathology, Washington, DC. , Teresio MottaTeresio Motta From the Cardiovascular (G.G., G.M., O.V., M.T.) and Pathology Departments (T.M.), Ospedali Riuniti di Bergamo, Bergamo, Italy, and the Department of Cardiovascular Pathology (R.V., A.F.), Armed Forces Institute of Pathology, Washington, DC. and Renu VirmaniRenu Virmani From the Cardiovascular (G.G., G.M., O.V., M.T.) and Pathology Departments (T.M.), Ospedali Riuniti di Bergamo, Bergamo, Italy, and the Department of Cardiovascular Pathology (R.V., A.F.), Armed Forces Institute of Pathology, Washington, DC. Originally published11 Mar 2003https://doi.org/10.1161/01.CIR.0000062700.42060.6FCirculation. 2003;107:1340–1341A 71-year-old woman, enrolled in the RAndomized study with the sirolimus (SRL)–eluting Bx VELocity balloon-expandable stent (RAVEL) Trial (December 5, 2000), received a single SRL-eluting Bx Velocity stent (Cordis) to treat an 80% proximal left anterior descending (LAD) coronary artery stenosis (Figure 1A). Intravascular ultrasound and angiography at 6 months showed 0% stenosis with no in-stent neointimal proliferation (Figure 1, B and D). The patient remained asymptomatic until presenting with unstable angina on May 3, 2002. Angiography demonstrated subtotal occlusion of the left obtuse marginal. The LAD SRL-eluting stent (deployed 16 months previously) showed 0% stenosis (Figure 1C). The left obtuse marginal lesion was successfully stented, but the patient suffered a fatal stroke 24 hours after coronary intervention. Download figureDownload PowerPointFigure 1. Angiogram of the LAD showing 80% lumen diameter stenosis just before Bx Velocity SRL-eluting stent placement (panel A, anteroposterior cranial view). There was 0% angiographic narrowing of the stent (arrows) at 6 months (B) and 16 months (C). Panel D shows intravascular ultrasound of the proximal and distal reference (Ref) segments and 4 cross sections of the stented segments of the artery; note the absence of neointima at 6 months.At autopsy, the LAD SRL-eluting stent was widely patent, and there was a minute thrombus at the ostium of a small side branch (Figure 2A). The stent surface was otherwise well healed. Light microscopy showed mild neointimal thickening (smooth muscle cells within a proteoglycan-rich matrix; Figure 2, B through D). Fibrin was occasionally identified near stent struts, especially within the necrotic core, and was minimal within the neointima (Figure 2, E and F). Inflammatory cells were rare. Scanning electron microscopy showed >80% endothelialization of the stent (Figure 2G). There were small foci of poorly formed endothelial cell junctions and rare platelet aggregates close to the side branch ostium associated with pavement-shaped endothelial cells (Figure 2, H and I). Download figureDownload PowerPointFigure 2. The longitudinally cut Bx Velocity stent (A) has a translucent neointima and a small thrombus (arrow) at the distal end (at the ostium of a small side branch [white arrowhead]). A thin neointima (n) with rare giant cells (arrows) close to the strut (*) is shown in B. In C, 2 struts (*) are seen with one strut embedded in the necrotic core (**); note mild neointimal (n) formation. In D, a focal medial tear (arrow) with a strut (*) in contact with the external elastic lamina and adventitia is present. The overlying neointima (n) consists of a proteoglycan matrix containing numerous smooth muscle cells, which are shown in the boxed inset (α-actin stain). Fibrin stains (E and F, corresponding to D and C, respectively) demonstrate minimal surface staining (E) and strong staining around the strut (F) within the necrotic core. Scanning electron microscopy of the stent (G) shows >80% surface coverage by endothelium with minimal focal nonendothelialization at the distal end (arrow). In H and I, endothelial cells are pavement shaped with poorly formed cell junctions and a small surface platelet aggregate (arrow in I). B through D: Movat pentachrome stain.This SRL-eluting stent was widely patent at 16 months with >80% endothelial coverage. Neointimal healing was nearly complete, with only rare fibrin deposits.Dr Guagliumi has a consultant agreement with Cordis, the manufacturer of the stents that are the subject of this article.The online Figure is available as an online-only Data Supplement at http://www.circulationaha.org.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke's Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.FootnotesCorrespondence to Renu Virmani, MD, Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, 6825 16th St NW, Washington, DC 20306-6000. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Pelliccia F, Zimarino M, De Luca G, Viceconte N, Tanzilli G and De Caterina R (2022) Endothelial Progenitor Cells in Coronary Artery Disease: From Bench to Bedside, Stem Cells Translational Medicine, 10.1093/stcltm/szac010, 11:5, (451-460), Online publication date: 27-May-2022. 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