Author + information
- Received July 3, 2019
- Revision received September 6, 2019
- Accepted October 22, 2019
- Published online February 17, 2020.
- Salomé H. Kuntz, MDa,b,c,
- Sho Torii, MD, PhDa,
- Hiroyuki Jinnouchi, MDa,
- Anne Cornelissen, MDa,d,
- Atsushi Sakamoto, MD, PhDa,
- Yu Sato, MDa,
- Matthew Kutyna, MSa,
- Maria E. Romero, MDa,
- Anne Lejay, MDb,c,
- Adeline Schwein, MDb,c,
- Emilie Bonnin, MDb,c,
- Aloke V. Finn, MDa,e,
- Nabil Chakfé, MD, PhDb,c and
- Renu Virmani, MDa,∗ ()
- aCVPath Institute, Gaithersburg, Maryland
- bDepartment of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- cGEPROVAS, Strasbourg, France
- dUniversity Hospital RWTH, Aachen, Germany
- eUniversity of Maryland School of Medicine, Baltimore, Maryland
- ↵∗Address for correspondence:
Dr. Renu Virmani, CVPath Institute, 19 Firstfield Road, Gaithersburg, Maryland 20878.
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.
This study was funded by the CVPath Institute and GEPROVAS. Dr. Torii has received research grants from SUNRISE lab. Drs. Virmani and Finn have received institutional research support from R01 HL141425 Leducq Foundation grant, 480 Biomedical, 4C Medical, 4Tech, Abbott, Accumedical, Amgen, Biosensors, Boston Scientific, Cardiac Implants, Celonova, Claret Medical, Concept Medical, Cook, CSI, DuNing, Edwards Lifesciences, Emboline, Endotronix, Envision Scientific, Lutonix/Bard, Gateway, Lifetech, Limflo, MedAlliance, Medtronic, Mercator, Merill, Microport Medical, Microvention, Mitraalign, Mitra assist, NAMSA, Nanova, Neovasc, NIPRO, Novogate, Occulotech, OrbusNeich Medical, Phenox, Profusa, Protembis, Qool, Recor, Senseonics, Shockwave, Sinomed, Spectranetics, Surmodics, Symic, Vesper, W.L. Gore, and Xeltis. Dr. Finn has received honoraria from Abbott Vascular, Biosensors, Boston Scientific, Celonova, Cook Medical, CSI, Lutonix Bard, Sinomed, and Terumo Corporation; and is a consultant to Amgen, Abbott Vascular, Boston Scientific, Celonova, Cook Medical, Lutonix Bard, and Sinomed. Dr. Cornelissen has received research grants from University Hospital RWTH Aachen. Dr. Virmani has received honoraria from Abbott Vascular, Biosensors, Boston Scientific, Celonova, Cook Medical, Cordis, CSI, Lutonix Bard, Medtronic, OrbusNeich Medical, CeloNova, SINO Medical Technology, ReCore, Terumo Corporation, W. L. Gore, and Spectranetics; and is a consultant for Abbott Vascular, Boston Scientific, Celonova, Cook Medical, Cordis, CSI, Edwards Lifesciences, Lutonix Bard, Medtronic, OrbusNeich Medical, ReCore, Sinomededical Technology, Spectranetics, Surmodics, Terumo Corporation, W. L. Gore, and Xeltis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 3, 2019.
- Revision received September 6, 2019.
- Accepted October 22, 2019.
- 2020 American College of Cardiology Foundation
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