Abstract
First generation drug-eluting stents (DES) have significantly improved the treatment options for patients with symptomatic coronary artery disease by decreasing rates of acute vessel closure and restenosis after percutaneous coronary revascularization procedures. However, early enthusiasm was temperd by reports of late stent thrombosis (LST), which raised concerns about safety. Since millions of DES have been implanted in patients worldwide, it is imperative to understand the pathology of DES in man. Autopsy studies from the CVPath DES registry documented that delayed arterial healing is accompanied by poor endothelialization of stent struts which is the single best predictor of late stent thrombosis. Arterial healing of DES is highly heterogeneous and is dependent on underlying plaque morphology as well as on the stent location. We identified several anatomical and pathological changes in man, which were associated with LST; these include hypersensitivity reaction to polymer, plaque rupture, bifurcation sites, malapposition and stent fracture. DES was also associated with premature atherosclerotic changes versus BMS.
Keywords: Stent thrombosis, pathology, DES, delayed healing, bifurcation, malapposition, hypersensitivity, myocardial infarction, atherosclerotic change, Drug-Eluting Stent, coronary artery disease, restenosis, late stent thrombosis, Autopsy, plaque rupture, polymer-based sirolimus, paclitaxel, drug-eluting stents, Academic Research Consortium, lymphocytes, polyethylene-covinyl acetate, bare-metal ST, Cypher, optical coherence tomography, lipoproteins, V-Stenting, T-Stenting, Crush-Stenting, Culotte- Stenting, left obtuse marginal (LOM) artery, macrophages
Current Pharmaceutical Design
Title: Pathobiology of Stent Thrombosis after Drug-Eluting Stent Implantation
Volume: 16 Issue: 36
Author(s): Marc Vorpahl, Saami K. Yazdani, Masataka Nakano, Elena Ladich, Frank D. Kolodgie, Aloke V. Finn and Renu Virmani
Affiliation:
Keywords: Stent thrombosis, pathology, DES, delayed healing, bifurcation, malapposition, hypersensitivity, myocardial infarction, atherosclerotic change, Drug-Eluting Stent, coronary artery disease, restenosis, late stent thrombosis, Autopsy, plaque rupture, polymer-based sirolimus, paclitaxel, drug-eluting stents, Academic Research Consortium, lymphocytes, polyethylene-covinyl acetate, bare-metal ST, Cypher, optical coherence tomography, lipoproteins, V-Stenting, T-Stenting, Crush-Stenting, Culotte- Stenting, left obtuse marginal (LOM) artery, macrophages
Abstract: First generation drug-eluting stents (DES) have significantly improved the treatment options for patients with symptomatic coronary artery disease by decreasing rates of acute vessel closure and restenosis after percutaneous coronary revascularization procedures. However, early enthusiasm was temperd by reports of late stent thrombosis (LST), which raised concerns about safety. Since millions of DES have been implanted in patients worldwide, it is imperative to understand the pathology of DES in man. Autopsy studies from the CVPath DES registry documented that delayed arterial healing is accompanied by poor endothelialization of stent struts which is the single best predictor of late stent thrombosis. Arterial healing of DES is highly heterogeneous and is dependent on underlying plaque morphology as well as on the stent location. We identified several anatomical and pathological changes in man, which were associated with LST; these include hypersensitivity reaction to polymer, plaque rupture, bifurcation sites, malapposition and stent fracture. DES was also associated with premature atherosclerotic changes versus BMS.
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Vorpahl Marc, K. Yazdani Saami, Nakano Masataka, Ladich Elena, D. Kolodgie Frank, V. Finn Aloke and Virmani Renu, Pathobiology of Stent Thrombosis after Drug-Eluting Stent Implantation, Current Pharmaceutical Design 2010; 16 (36) . https://dx.doi.org/10.2174/138161210794454879
DOI https://dx.doi.org/10.2174/138161210794454879 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
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