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(Circulation. 2003;107:1340.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Sirolimus-Eluting Stent Implanted in Human Coronary Artery for 16 Months

Pathological Findings

Giulio Guagliumi, MD; Andrew Farb, MD; Giuseppe Musumeci, MD; Orazio Valsecchi, MD; Maurizio Tespili, MD; Teresio Motta, MD; Renu Virmani, MD

From the Cardiovascular (G.G., G.M., O.V., M.T.) and Pathology Departments (T.M.), Ospedali Riuniti di Bergamo, Bergamo, Italy, and the Department of Cardiovascular Pathology (R.V., A.F.), Armed Forces Institute of Pathology, Washington, DC.

Correspondence to Renu Virmani, MD, Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, 6825 16th St NW, Washington, DC 20306-6000. E-mail virmani@afip.osd.mil

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

A 71-year-old woman, enrolled in the RAndomized study with the sirolimus (SRL)–eluting Bx VELocity balloon-expandable stent (RAVEL) Trial (December 5, 2000), received a single SRL-eluting Bx Velocity stent (Cordis) to treat an 80% proximal left anterior descending (LAD) coronary artery stenosis (Figure 1A). Intravascular ultrasound and angiography at 6 months showed 0% stenosis with no in-stent neointimal proliferation (Figure 1, B and D). The patient remained asymptomatic until presenting with unstable angina on May 3, 2002. Angiography demonstrated subtotal occlusion of the left obtuse marginal. The LAD SRL-eluting stent (deployed 16 months previously) showed 0% stenosis (Figure 1C). The left obtuse marginal lesion was successfully stented, but the patient suffered a fatal stroke 24 hours after coronary intervention.

View larger version (88K): [in this window] [in a new window]   Figure 1. Angiogram of the LAD showing 80% lumen diameter stenosis just before Bx Velocity SRL-eluting stent placement (panel A, anteroposterior cranial view). There was 0% angiographic narrowing of the stent (arrows) at 6 months (B) and 16 months (C). Panel D shows intravascular ultrasound of the proximal and distal reference (Ref) segments and 4 cross sections of the stented segments of the artery; note the absence of neointima at 6 months.

At autopsy, the LAD SRL-eluting stent was widely patent, and there was a minute thrombus at the ostium of a small side branch (Figure 2A). The stent surface was otherwise well healed. Light microscopy showed mild neointimal thickening (smooth muscle cells within a proteoglycan-rich matrix; Figure 2, B through D). Fibrin . . . [Full Text of this Article]

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