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(Circulation. 2002;106:1176.)
© 2002 American Heart Association, Inc.

Images in Cardiovascular Medicine

Stent Inflammation

Stent Footprint in Restenotic Tissue Retrieved by Directional Atherectomy

Martijn Meuwissen, MD; Allard C. van der Wal, MD; Robbert J. de Winter, MD; Karel T. Koch, MD; Anton E. Becker, MD; Jan J. Piek, MD

From the Departments of Cardiology (M.M., R.J.d.W., K.T.K., J.J.P.) and Cardiovascular Pathology (A.C.v.d.W., A.E.B.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Correspondence to Jan J. Piek, MD, Dept of Cardiology, B2-108, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands, PO Box 22700, 1100 DE Amsterdam, The Netherlands. E-mail m.meuwissen@amc.uva.nl

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 68-year-old woman was treated for diffuse in-stent restenosis 5 months after implantation of a 13-mm Multilink stent (Guidant) in the proximal segment of the right coronary artery (Figure 1A). Debulking of the in-stent restenotic lesion was performed using directional coronary atherectomy (DCA) followed by adjunctive balloon angioplasty (Figure 1B). Six months after atherectomy, the patient was asymptomatic and routine coronary angiography demonstrated a good long-term result (Figure 1C). Macroscopic examination of the retrieved DCA specimen revealed a partially removed stent strut (arrow, Figure 2A) within transparent blueish homogeneous tissue. The atherectomy specimen was analyzed histologically and contained mainly smooth muscle cells. At regular intervals along the edge, distinct clusters of T lymphocytes and macrophages (not shown) occurred, suggesting inflammatory cell clustering at the site of stent struts (Figures 2B and 2C). These immunohistochemical images illustrate a stent-strut– induced inflammation of an in-stent restenotic lesion retrieved by DCA.

View larger version (60K): [in this window] [in a new window]   Figure 1. A, Coronary angiogram of the right coronary artery, showing a severe, proximal in-stent restenotic lesion. B, Coronary angiogram directly after directional coronary atherectomy followed by adjunct balloon angioplasty. C, Coronary angiogram at 6-month follow-up.

View larger version (70K): [in this window] [in a new window]   Figure 2. A, Macroscopic view of the retrieved atherectomy specimen. Arrow indicates a partially removed stent strut. B, Anti–1-smooth muscle actin (SMA-1) staining shows predominantly smooth muscle cells. C, CD-3 staining shows clustered inflammatory (T) cells at regular intervals along the edge of the atherectomy specimen, representing stent-strut–induced inflammatory processes (asterisks).

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