Pathologic Etiologies of Late and Very Late Stent Thrombosis following First-Generation Drug-Eluting Stent Placement
Figure 7
Representative cases showing atherosclerotic change following BMS, SES, and PES implantation. (a to c) Histologic sections from a 65-year-old woman with a paclitaxel-eluting stent (PES) implanted in the left circumflex artery 14 months antemortem, who died of traumatic brain injury. A low power image shows a patent lumen with moderate neointimal growth (a); foamy macrophage infiltration and necrotic core formation with cholesterol clefts are seen at high magnification in (b). (c) Same section as (b) showing CD68 positive macrophages in the neointima. (d to f) Histological sections from a 59-year-old male with sirolimus-eluting stents (SES) implanted for 23 months who died from stent thrombosis (d). Note thin-cap fibroatheroma with fibrous cap disruption in (e) (arrows) from boxed area in (d). The thrombus (Th) was more apparent in the distal section taken 3 mm apart (d). (f) shows CD 68 positive macrophages in the fibrous cap and in the underlying necrotic core. (g to i) Histologic section from a 47-year-old male who had a bare metal stents (BMS) implanted 8 years prior to death. Note occlusive thrombus (Th) in the lumen and ruptured plaque (boxed area in (g)), which is shown at higher magnification in (h) with large number of macrophages within the lumen as well as at the ruptured cap. Note large number of CD 68 positive macrophages at the site of rupture (i). (Reproduced with permission from [12].)
