Intravascular ultrasound, angioscopic and histopathological characterisation of heterogeneous patterns of restenosis after sirolimus-eluting stent implantation: Insights into potential "thromborestenosis" phenomenon

Yuji Oikawa, Junji Yajima, Marco A. Costa, Shunsuke Matsuno, Masafumi Akabane, Ryuichi Funada, Toshiro Inaba, Yuya Nakagawa, Michinari Nakamura, Kazuyuki Nagashima, Hajime Kirigaya, Ken Ogasawara, Hitoshi Sawada, Tadanori Aizawa

Research output: Contribution to journalArticlepeer-review

33 Scopus citations

Abstract

Aims: Histopathology of DES restenosis remains unclear. The purpose is to examine restenotic tissue characteristics after sirolimus-eluting stent (SES) and comparing with that after bare-metal stent (BMS). Methods and results: Intravascular ultrasound (IVUS), coronary angioscopy (CAS), and directional coronary atherectomy were performed simultaneously in 21 patients who presented restenosis after SES (n=13) and BMS (n=8). Mean time of restenosis was 10.8 months in the SES versus 7.5 months in the BMS. Typical "black hole", echolucent appearance by IVUS was observed in one SES case, and corresponded to a fibrin rich tissue by histology which appeared translucent tissue by CAS. CAS did not reveal red thrombus, but showed white thrombus in six SES versus two BMS (46.2% vs. 25.0%, p=0.597). Histology demonstrated various patterns after SES including thrombus, fibrin, inflammatory infiltrate, and collagen-matrix rich tissue, while thrombus component was not detected in BMS. Thrombus and fibrin deposition detected by either CAS or histopathology were observed more frequently in SES than in BMS group (92.3% vs. 25.0%, p=0.007). Conclusions: Restenosis after SES and BMS have different clinical and histological patterns. SES restenosis may be frequently associated with thrombus component.

Original languageEnglish (US)
Pages (from-to)380-387
Number of pages8
JournalEuroIntervention
Volume6
Issue number3
DOIs
StatePublished - Aug 1 2010
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Keywords

  • Atherectomy
  • Bare metal stent
  • Sirolimus-eluting stent

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