Imai Masao, Kimura Takeshi, Tazaki Junichi, Yamamoto Erika, Inoue Katsumi
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shougoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
Kokura Memorial Hospital, Kokura, Japan.
J Cardiol Cases. 2013 Sep 26;8(5):145-147. doi: 10.1016/j.jccase.2013.07.006. eCollection 2013 Nov.
A 73-year-old man underwent sirolimus-eluting stent (SES) implantation for chest pain on exertion with left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCX). The patient died due to non-obstructive mesenteric ischemia after 57 months of SES implantation. An autopsy demonstrated that the lesions of stented site at LAD and LCX were histopathologicaly similar images. In short, only mild neointimal formation with enough patent lumen was observed in all stented sites with no evidence of restenosis. In addition, complete coverage of endothelial cells in the surface of neointima was visible. Furthermore, necrotic core formation with a lot of circumferential cholesterol clefts was evident around the struts. In spite of these findings, observations of neointimal rupture and stent thrombosis were not found in this very late period autopsy study. In this histopathological examination, although neointimal coverage with enough lumen was observed, accumulation of extracellular lipid and cholesterol crystal was shaping necrotizing core, in short neoatherosclerosis. In the future, biocompatible drug-eluting stents which do not induce inflammation to the arterial wall post stenting should be appropriately addressed by the future development of improved coronary stents. < This manuscript contains original materials from pathological analysis of very long-term SES implantation. The current case report is the first one with very long-term course after SES implantation over 4 years and 9 months. In this pathological examination, although neointimal coverage with enough lumen was observed, neoatherosclerotic change around stent struts was evident. We should observe close clinical follow up after SES implantation.>.
一名73岁男性因劳力性胸痛接受了西罗莫司洗脱支架（SES）植入术，病变位于左前降支冠状动脉（LAD）和左旋支冠状动脉（LCX）。SES植入57个月后，患者因非阻塞性肠系膜缺血死亡。尸检显示，LAD和LCX支架置入部位的病变在组织病理学上具有相似的图像。简而言之，在所有支架置入部位仅观察到轻度新生内膜形成，管腔通畅，无再狭窄证据。此外，可见新生内膜表面内皮细胞完全覆盖。此外，支架周围可见坏死核心形成，有大量环形胆固醇裂隙。尽管有这些发现，但在这项极晚期尸检研究中未发现新生内膜破裂和支架血栓形成。在这项组织病理学检查中，尽管观察到新生内膜覆盖且管腔足够，但细胞外脂质和胆固醇结晶的积聚正在形成坏死核心，即新动脉粥样硬化。未来，在改进冠状动脉支架的研发中，应适当关注不会在支架置入后对动脉壁产生炎症反应的生物相容性药物洗脱支架。<本手稿包含来自长期SES植入病理分析的原始材料。本病例报告是SES植入超过4年9个月后的首个长期病例报告。在这项病理检查中，尽管观察到新生内膜覆盖且管腔足够，但支架周围的新动脉粥样硬化改变明显。SES植入后我们应密切进行临床随访。>
