Salomé H Kuntz1, Sho Torii2, Hiroyuki Jinnouchi2, Anne Cornelissen3, Atsushi Sakamoto2, Yu Sato2, Matthew Kutyna2, Maria E Romero2, Anne Lejay4, Adeline Schwein4, Emilie Bonnin4, Aloke V Finn5, Nabil Chakfé4, Renu Virmani6. 1. CVPath Institute, Gaithersburg, Maryland; Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France; GEPROVAS, Strasbourg, France. 2. CVPath Institute, Gaithersburg, Maryland. 3. CVPath Institute, Gaithersburg, Maryland; University Hospital RWTH, Aachen, Germany. 4. Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France; GEPROVAS, Strasbourg, France. 5. CVPath Institute, Gaithersburg, Maryland; University of Maryland School of Medicine, Baltimore, Maryland. 6. CVPath Institute, Gaithersburg, Maryland. Electronic address: rvirmani@cvpath.org.
Abstract
OBJECTIVES: The objective of this study was to comprehensively evaluate the pathology of acute and chronic femoral stenting in symptomatic atherosclerotic patients and to understand the causes of stent failure (SF) using multimodality imaging including micro-computed tomography. BACKGROUND: Although the pathology of coronary stenting has been well studied, the pathology of lower extremity femoral stenting remains poorly understood. METHODS: Twelve stented femoral lesions removed at surgery (n = 10) and at autopsy (n = 2) were obtained from 10 patients (median age 74 years; interquartile range [IQR]: 66 to 82 years) with histories of peripheral artery disease (critical limb ischemia in 7) (7 men and 3 women). All specimens underwent radiography, micro-computed tomography, and histological assessment. RESULTS: The median duration of implantation was 150 days (IQR: 30 to 365 days), the median stent diameter was 5.90 mm (IQR: 5.44 to 7.16 mm), and the median stent length was 39.5 mm (IQR: 27 to 107.5 mm). Of the 12 stented lesions, 2 had drug-eluting stents, and 10 had bare-metal stents. SF was observed in 8 of 12 lesions. The major cause of SF was acute thrombosis (6 of 8), but causes varied (delayed healing, stent underexpansion, false lumen stenting, and fracture), and 2 had restenosis. Stent fractures were observed in 3 cases by micro-computed tomography. Both drug-eluting stents, implanted for >1 year, showed delayed healing with circumferential peristrut fibrin deposition and SF. CONCLUSIONS: This histological study is the first to examine the pathological cause of SF. Stent thrombosis was the major cause of SF. Delayed healing was a common feature of bare-metal stents implanted for <90 days, while all drug-eluting stents, despite implantation duration >1 year, showed delayed healing.
OBJECTIVES: The objective of this study was to comprehensively evaluate the pathology of acute and chronic femoral stenting in symptomatic atheroscleroticpatients and to understand the causes of stent failure (SF) using multimodality imaging including micro-computed tomography. BACKGROUND: Although the pathology of coronary stenting has been well studied, the pathology of lower extremity femoral stenting remains poorly understood. METHODS: Twelve stented femoral lesions removed at surgery (n = 10) and at autopsy (n = 2) were obtained from 10 patients (median age 74 years; interquartile range [IQR]: 66 to 82 years) with histories of peripheral artery disease (critical limb ischemia in 7) (7 men and 3 women). All specimens underwent radiography, micro-computed tomography, and histological assessment. RESULTS: The median duration of implantation was 150 days (IQR: 30 to 365 days), the median stent diameter was 5.90 mm (IQR: 5.44 to 7.16 mm), and the median stent length was 39.5 mm (IQR: 27 to 107.5 mm). Of the 12 stented lesions, 2 had drug-eluting stents, and 10 had bare-metal stents. SF was observed in 8 of 12 lesions. The major cause of SF was acute thrombosis (6 of 8), but causes varied (delayed healing, stent underexpansion, false lumen stenting, and fracture), and 2 had restenosis. Stent fractures were observed in 3 cases by micro-computed tomography. Both drug-eluting stents, implanted for >1 year, showed delayed healing with circumferential peristrut fibrin deposition and SF. CONCLUSIONS: This histological study is the first to examine the pathological cause of SF. Stent thrombosis was the major cause of SF. Delayed healing was a common feature of bare-metal stents implanted for <90 days, while all drug-eluting stents, despite implantation duration >1 year, showed delayed healing.