Virmani Renu, Guagliumi Giulio, Farb Andrew, Musumeci Giuseppe, Grieco Niccolo, Motta Teresio, Mihalcsik Laurian, Tespili Maurizio, Valsecchi Orazio, Kolodgie Frank D
Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, 6825 16th St NW, Washington, DC, USA.
Circulation. 2004 Feb 17;109(6):701-5. doi: 10.1161/01.CIR.0000116202.41966.D4. Epub 2004 Jan 26.
The US Food and Drug Administration recently issued a warning of subacute thrombosis and hypersensitivity reactions to sirolimus-eluting stents (Cypher). The cause and incidence of these events have not been determined.
We present findings of a 58-year-old man who died of late stent thrombosis 18 months after receiving 2 Cypher stents for unstable angina. Although angiographic and intravascular ultrasound results at 8 months demonstrated the absence of neointimal formation, vessel enlargement was present. An autopsy showed aneurysmal dilation of the stented arterial segments with a severe localized hypersensitivity reaction consisting predominantly of T lymphocytes and eosinophils.
The known pharmacokinetic elution profile of Cypher stents and the presence of polymer fragments surrounded by giant cells and eosinophils suggest that a reaction to the polymer may have caused late stent thrombosis. Careful long-term follow-up of patients with vessel enlargement after Cypher stent placement is recommended.
美国食品药品监督管理局最近发布了关于西罗莫司洗脱支架（Cypher）的亚急性血栓形成和超敏反应的警告。这些事件的原因和发生率尚未确定。
我们报告了一名58岁男性的病例，该患者在因不稳定型心绞痛接受2个Cypher支架植入18个月后死于晚期支架血栓形成。尽管8个月时的血管造影和血管内超声结果显示无新生内膜形成，但存在血管扩张。尸检显示支架植入的动脉节段呈动脉瘤样扩张，伴有以T淋巴细胞和嗜酸性粒细胞为主的严重局部超敏反应。
Cypher支架已知的药代动力学洗脱曲线以及被巨细胞和嗜酸性粒细胞包围的聚合物碎片的存在表明，对聚合物的反应可能导致了晚期支架血栓形成。建议对Cypher支架植入后血管扩张的患者进行仔细的长期随访。
