CVPath Institute, Gaithersburg, Maryland; Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France; GEPROVAS, Strasbourg, France.
CVPath Institute, Gaithersburg, Maryland.
JACC Cardiovasc Interv. 2020 Feb 24;13(4):418-427. doi: 10.1016/j.jcin.2019.10.060.
The objective of this study was to comprehensively evaluate the pathology of acute and chronic femoral stenting in symptomatic atherosclerotic patients and to understand the causes of stent failure (SF) using multimodality imaging including micro-computed tomography.
Although the pathology of coronary stenting has been well studied, the pathology of lower extremity femoral stenting remains poorly understood.
Twelve stented femoral lesions removed at surgery (n = 10) and at autopsy (n = 2) were obtained from 10 patients (median age 74 years; interquartile range [IQR]: 66 to 82 years) with histories of peripheral artery disease (critical limb ischemia in 7) (7 men and 3 women). All specimens underwent radiography, micro-computed tomography, and histological assessment.
The median duration of implantation was 150 days (IQR: 30 to 365 days), the median stent diameter was 5.90 mm (IQR: 5.44 to 7.16 mm), and the median stent length was 39.5 mm (IQR: 27 to 107.5 mm). Of the 12 stented lesions, 2 had drug-eluting stents, and 10 had bare-metal stents. SF was observed in 8 of 12 lesions. The major cause of SF was acute thrombosis (6 of 8), but causes varied (delayed healing, stent underexpansion, false lumen stenting, and fracture), and 2 had restenosis. Stent fractures were observed in 3 cases by micro-computed tomography. Both drug-eluting stents, implanted for >1 year, showed delayed healing with circumferential peristrut fibrin deposition and SF.
This histological study is the first to examine the pathological cause of SF. Stent thrombosis was the major cause of SF. Delayed healing was a common feature of bare-metal stents implanted for <90 days, while all drug-eluting stents, despite implantation duration >1 year, showed delayed healing.
本研究旨在综合评估有症状粥样硬化患者急性和慢性股动脉支架置入后的病理学表现，并利用包括微计算机断层扫描在内的多种成像方式了解支架失败（SF）的原因。
尽管冠状动脉支架的病理学已有深入研究，但股动脉支架置入后的病理学仍知之甚少。
从 10 例有外周动脉疾病病史（7 例为严重肢体缺血）的患者（7 名男性，3 名女性；中位年龄 74 岁；四分位距 [IQR]：66 至 82 岁）手术（n=10）和尸检（n=2）中获取 12 处支架置入的股动脉病变。所有标本均进行放射学、微计算机断层扫描和组织学评估。
植入中位时间为 150 天（IQR：30 至 365 天），支架中位直径为 5.90 毫米（IQR：5.44 至 7.16 毫米），支架中位长度为 39.5 毫米（IQR：27 至 107.5 毫米）。12 处支架置入病变中，2 处为药物洗脱支架，10 处为裸金属支架。12 处病变中有 8 处发生 SF。SF 的主要原因是急性血栓形成（8 处中的 6 处），但原因各异（延迟愈合、支架扩张不足、假腔支架置入和骨折），2 处发生再狭窄。微计算机断层扫描显示 3 例存在支架骨折。2 枚植入时间超过 1 年的药物洗脱支架均表现为愈合延迟，支架周围可见环状纤维蛋白沉积和 SF。
本组织学研究首次检查了 SF 的病理原因。支架血栓形成是 SF 的主要原因。裸金属支架植入 <90 天内常见延迟愈合，而所有药物洗脱支架，尽管植入时间超过 1 年，均表现为愈合延迟。
