Stent Footprint in Restenotic Tissue Retrieved by Directional Atherectomy
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.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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