Document Detail


Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk.
MedLine Citation:
PMID:  16814667     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study examined human drug-eluting stents (DES) to determine the long-term effects of these stents on coronary arterial healing and identified mechanisms underlying late stent thrombosis (LST). BACKGROUND: Although DES reduce the need for repeat revascularization compared with bare-metal stents (BMS), data suggest the window of thrombotic risk for Cypher (Cordis Corp., Miami Lakes, Florida) and Taxus (Boston Scientific Corp., Natick, Massachusetts) DES extends far beyond that for BMS. METHODS: From a registry of 40 autopsies of DES (68 stents), 23 DES cases of >30 days duration were compared with 25 matched autopsies of BMS implantation. Late stent thrombosis was defined as an acute thrombus within a stent >30 days old. RESULTS: Of 23 patients with DES >30 days old, 14 had evidence of LST. Cypher and Taxus DES showed greater delayed healing characterized by persistent fibrin deposition (fibrin score 2.3 +/- 1.1 vs. 0.9 +/- 0.8, p = 0.0001) and poorer endothelialization (55.8 +/- 26.5%) compared with BMS (89.8 +/- 20.9, p = 0.0001). Moreover, DES with LST showed more delayed healing compared with patent DES. In 5 of 14 patients suffering LST, antiplatelet therapy had been withdrawn. Additional procedural and pathologic risk factors for LST were: 1) local hypersensitivity reaction; 2) ostial and/or bifurcation stenting; 3) malapposition/incomplete apposition; 4) restenosis; and 5) strut penetration into a necrotic core. CONCLUSIONS: The Cypher and Taxus DES result in delayed arterial healing when compared with BMS of similar implant duration. The cause of DES LST is multifactorial with delayed healing in combination with other clinical and procedural risk factors playing a role.
Authors:
Michael Joner; Aloke V Finn; Andrew Farb; Erik K Mont; Frank D Kolodgie; Elena Ladich; Robert Kutys; Kristi Skorija; Herman K Gold; Renu Virmani
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-05-05
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  48     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-07-03     Completed Date:  2006-07-28     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  193-202     Citation Subset:  AIM; IM    
Affiliation:
CVPath, International Registry of Pathology, Gaithersburg, Maryland 20878, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Coronary Restenosis
Coronary Thrombosis / etiology*,  mortality
Coronary Vessels / pathology*
Death, Sudden, Cardiac
Female
Humans
Male
Metals
Middle Aged
Myocardial Infarction / etiology,  mortality
Paclitaxel*
Sirolimus*
Stents / adverse effects*
Wound Healing*
Chemical
Reg. No./Substance:
0/Metals; 33069-62-4/Paclitaxel; 53123-88-9/Sirolimus
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2006 Jul 4;48(1):203-5   [PMID:  16814668 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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