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(Circulation. 2000;101:e33.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

Angiotensin-Converting Enzyme Tissue Activity in the Diffuse In-Stent Restenotic Plaque

Flavio Ribichini, MD; Francesco Pugno, MD; Valeria Ferrero, MD; Gianni Bussolati, MD, FRCPath; Germano Melissano, MD; Roberto Chiesa, MD; Carlo Di Mario, MD; Antonio Colombo, MD

From the Cardiac Catheterization Laboratory and Division of Cardiology (F.R., V.F.) and the Laboratory of Human Pathology (F.P.), Ospedale Santa Croce, Cuneo; the Department of Biomedical Science, Università di Torino (G.B.); and the Department of Vascular Surgery, Ospedale San Raffaele (G.M., R.C.) and Cardiac Catheterization Laboratory, Centro Cuore Columbus–Ospedale San Raffaele (C.D.M., A.C.), Milano, Italy.

Correspondence to Flavio Ribichini, MD, Laboratorio di Emodinamica, Ospedale Santa Croce, Via Michele Copino 26, 12100 Cuneo, Italy. E-mail emodinamica@scroce.sanitacn.it

	Introduction

 
We present the 6-month anatomic, histological, and immunohistochemical (IHC) images of a diffuse and aggressive type of in-stent restenosis of a popliteal artery of a patient homozygous for the D (deletion) allele of the ACE gene (Figures 1, 2, and 3).

View larger version (123K): [in this window] [in a new window]   Figure 1. Macroscopic view of a section of artery showing diffuse tissue growth within stent wires.

View larger version (135K): [in this window] [in a new window]   Figure 2. Hematoxylin-eosin microscopy of the arterial wall after removal of the metallic struts of the stent. Right, Muscularis of media of arterial wall. Around wire is a "wire cuffing" composed of inflammatory and spindle-shaped cells. Left, Core of restenotic plaque shows spindle-shaped cells and neovessels.

View larger version (87K): [in this window] [in a new window]   Figure 3. Amplification of wire cuffing tissue. IHC for ACE (Biomedicals Ag) and for -actin (Dako) shows that (A) spindle-shaped cells in contact with metallic wires stain for ACE, and (B) spindle-shaped cells of plaque core, but not those close to stent wires, stain intensively for -actin.

A detailed description of the histological changes of the arterial wall with time after coronary stenting in humans was published recently.¹ These findings have confirmed that the ultrasound-detected "neointima" observed >1 month after implantation is composed primarily of smooth muscle cells (SMCs) and a proteoglycan-rich matrix. In the first weeks after stenting, the metallic struts associate with inflammatory cells, local thrombus formation, and "dedifferentiated" -actin–negative spindle-shaped cells. Later, multinucleated giant cells and -actin–positive spindle-shaped cells are observed in a more differentiated fibrocellular lesion.^{1 2} ACE increases up to 100-fold during the transformation of monocytes to macrophages, and most of the dedifferentiated SMCs (-actin–negative . . . [Full Text of this Article]

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