Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan.
Cardiovasc Pathol. 2012 Nov-Dec;21(6):511-4. doi: 10.1016/j.carpath.2012.01.003. Epub 2012 Feb 21.
An 86-year-old man died suddenly 5 months after implantation of a zotarolimus-eluting stent. Two zotarolimus-eluting stents were placed to treat a highly calcified diffuse lesion in the proximal-to-mid right coronary artery. The lesion was fully covered by the two stents, and intravascular ultrasound showed complete stent apposition. However, an X-ray at autopsy showed that the proximal stent was fractured. Although we thought that thrombotic occlusion at the fracture site might have caused his sudden death, no thrombus was present. In addition, in the other sites where the stents were optimally dilated, there was stent malapposition and peri-strut inflammation including macrophage infiltration, giant cells, polymer phagocytosis, and neovascularization in the neointima. Even with a second-generation drug-eluting stent, such as the zotarolimus-eluting stent, wound healing may be impaired at the stent-injured vessel site.
一位 86 岁男性在植入依维莫司洗脱支架后 5 个月突然死亡。为治疗右冠状动脉近段至中段弥漫性严重钙化病变，置入两枚依维莫司洗脱支架。两枚支架完全覆盖病变，血管内超声显示支架贴壁完全。然而，尸检 X 线显示近端支架断裂。虽然我们考虑到断裂部位的血栓闭塞可能导致他的猝死，但并未发现血栓。此外，在支架充分扩张的其他部位，存在支架贴壁不良以及支架内炎症，包括巨噬细胞浸润、巨细胞、聚合物吞噬和新生内膜中的新生血管形成。即使使用第二代药物洗脱支架，如依维莫司洗脱支架，支架损伤血管部位的愈合也可能受损。
