Pathologic Etiologies of Late and Very Late Stent Thrombosis following First-Generation Drug-Eluting Stent Placement
Figure 6
Representative images of the various stages of newly formed atherosclerotic changes within the neointima (neoatherosclerosis) following stent implantation. Foamy macrophage clusters in the peristrut region of sirolimus-eluting stents (SES) implanted for13 months antemortem is seen in (a). Fibroatheroma with foamy macrophage rich lesion and early necrotic core formation in SES of 13-month duration is shown in (b). Panel (c) shows fibroatheroma with peristrut early necrotic core, cholesterol clefts, surface foamy macrophages, and early calcification (arrow) in SES at 13 months. Peristrut late necrotic core in the neointima characterized by large aggregate of cholesterol cleft in SES at 17 months is shown in (d). Panel (e) shows fibroatheroma with calcification in the necrotic core in SES of 10-month duration. A peristrut calcification (arrow) with fibrin in SES of 7 months duration is shown in (f). (g and h) A low (h) and high power (g) magnification image of a severely narrowed bare metal stents (BMS) implanted 61 months with a thin-cap fibroatheroma. Note macrophage infiltration and a discontinuous thin fibrous cap (g). (i and j) A low magnification image shows a plaque rupture with an acute thrombus that has totally occluded the lumen in BMS implanted for 61 months antemortem (i). A high magnification image shows a discontinuous thin-cap with occlusive luminal thrombus (j). (Reproduced with permission from [12].)
