Ishibashi-Ueda H, Yutani C, Imakita M, Kuribayashi S, Takamiya M, Uchida H, Kichikawa K, Suzuki T
Department of Pathology, National Cardiovascular Center, Osaka, Japan.
Angiology. 1999 Dec;50(12):977-87. doi: 10.1177/000331979905001203.
Pathologically, restenotic lesions after stenting were investigated by use of atherectomized tissues of seven coronary and seven iliac arteries. The mean interval of the stent deployment to restenosis was 9.1 months for the coronary artery and 33.7 months for the iliac artery, indicating a 3.7-fold longer interval for the latter. This study does not include cases of acute thrombotic occlusion. The atherectomized tissue from restenotic coronary arteries showed abundant neointima with alpha-actin-positive and ultrastructually synthetic-type smooth muscle cells in a rich myxomatous extracellular matrix. In the iliac arteries, the predominant component of restenosis consisted of organized thrombi. The neointima of the iliac arteries was mature, and only a small amount of spindle cells were observed in the hyalinized matrix. The tissue that developed restenosis after stenting was different in the coronary and iliac arteries included in this series. This study on the atherectomized tissue suggests that even in the chronic stage, a major cause of in-stent restenosis among the larger caliber vessels such as the iliac artery is not neointima but stent thrombosis.
在病理学上，通过对7例冠状动脉和7例髂动脉旋切组织的研究来观察支架置入术后的再狭窄病变。冠状动脉从支架置入到再狭窄的平均间隔时间为9.1个月，髂动脉为33.7个月，表明后者的间隔时间长3.7倍。本研究不包括急性血栓闭塞病例。再狭窄冠状动脉的旋切组织显示内膜增生明显，α-肌动蛋白阳性且超微结构为合成型的平滑肌细胞存在于丰富的黏液瘤样细胞外基质中。在髂动脉中，再狭窄的主要成分是机化血栓。髂动脉内膜成熟，在玻璃样变基质中仅观察到少量梭形细胞。本系列研究中，冠状动脉和髂动脉支架置入术后发生再狭窄的组织有所不同。对旋切组织的这项研究表明，即使在慢性期，髂动脉等较大口径血管内支架再狭窄的主要原因不是内膜增生，而是支架血栓形成。
