Yamaji Kyohei, Kubo Shunsuke, Inoue Katsumi, Kadota Kazushige, Kuramitsu Shoichi, Shirai Shinichi, Ando Kenji, Nobuyoshi Masakiyo, Mitsudo Kazuaki, Kimura Takeshi
Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
PLoS One. 2014 Nov 25;9(11):e113870. doi: 10.1371/journal.pone.0113870. eCollection 2014.
Localized hypersensitivity reaction, delayed arterial healing, and neoatherosclerosis inside the stent have been suggested as the underlying pathologic mechanisms of very late stent thrombosis (VLST) of drug-eluting stent (DES). The present study sought to explore the prevalence of inflammatory cell infiltrates and evidence for fragments of atherosclerotic plaques in the aspirated thrombi in patients with DES VLST.
From April 2004 to September 2012, 48 patients with stent thrombosis (ST) of DES underwent thrombus aspiration with retrieved material sufficient for the histopathologic analysis; early ST (EST, within 30 days): N = 17, late ST (LST, between 31 and 365 days): N = 7, and very late ST (VLST, >1 year): N = 24. Eosinophil fraction in the aspirated thrombi was significantly higher in patients with VLST (8.2±5.7%) as compared with those with EST (4.3±3.0%) and LST (5.5±3.8%) (P = 0.03). Eosinophil fraction in the aspirated thrombi was significantly higher in 12 VLST patients with angiographic peri-stent contrast staining (PSS) and/or incomplete stent apposition (ISA) by intravascular ultrasound than in 12 VLST patients without PSS or ISA (10.6±6.1% versus 5.8±4.1%, P = 0.03). Evidences for fragments of atherosclerotic plaques in the aspirated thrombi were observed only in 3 (13%) out of 24 patients with DES VLST.
Eosinophil fraction in the aspirated thrombi was significantly higher in patients with DES VLST as compared with those with EST and LST. Evidences for fragments of atherosclerotic plaques were relatively uncommon in patients with DES VLST.
局部过敏反应、动脉愈合延迟以及支架内新生动脉粥样硬化被认为是药物洗脱支架（DES）极晚期支架血栓形成（VLST）的潜在病理机制。本研究旨在探讨DES-VLST患者吸出血栓中炎性细胞浸润的发生率以及动脉粥样硬化斑块碎片的证据。
2004年4月至2012年9月，48例DES支架血栓形成（ST）患者接受了血栓抽吸，获取的材料足以进行组织病理学分析；早期ST（EST，30天内）：N = 17，晚期ST（LST，31至365天）：N = 7，极晚期ST（VLST，>1年）：N = 24。与EST患者（4.3±3.0%）和LST患者（5.5±3.8%）相比，VLST患者吸出血栓中的嗜酸性粒细胞比例显著更高（8.2±5.7%）（P = 0.03）。血管内超声显示有血管造影剂支架周围染色（PSS）和/或支架贴壁不良（ISA）的12例VLST患者吸出血栓中的嗜酸性粒细胞比例显著高于无PSS或ISA的12例VLST患者（10.6±6.1%对5.8±4.1%，P = 0.03）。在24例DES-VLST患者中，仅3例（13%）观察到吸出血栓中有动脉粥样硬化斑块碎片的证据。
与EST和LST患者相比，DES-VLST患者吸出血栓中的嗜酸性粒细胞比例显著更高。DES-VLST患者中动脉粥样硬化斑块碎片的证据相对少见。
