Pathological Finding of Sirolimus-Eluting Stent (SES) Restenosis Lesion With Black Hole Appearance on Intravascular Ultrasound

Kenji Goto; Nobuo Shiode; Kinya Shirota; Yukihiro Fukuda; Fumiyo Kitamura; Koichi Tominaga; Yasuko Kato; Hiroshi Miura; Katsumi Inoue; Masakiyo Nobuyoshi

doi:10.1253/circj.CJ-08-0354

Case Reports

Pathological Finding of Sirolimus-Eluting Stent (SES) Restenosis Lesion With Black Hole Appearance on Intravascular Ultrasound

Kenji Goto, Nobuo Shiode, Kinya Shirota, Yukihiro Fukuda, Fumiyo Kitamura, Koichi Tominaga, Yasuko Kato, Hiroshi Miura, Katsumi Inoue, Masakiyo Nobuyoshi

Author information

Kenji Goto
Department of Cardiology, Matsue Red Cross Hospital
Nobuo Shiode
Department of Cardiology, Matsue Red Cross Hospital
Kinya Shirota
Department of Cardiology, Matsue Red Cross Hospital
Yukihiro Fukuda
Department of Cardiology, Matsue Red Cross Hospital
Fumiyo Kitamura
Department of Cardiology, Matsue Red Cross Hospital
Koichi Tominaga
Department of Cardiology, Matsue Red Cross Hospital
Yasuko Kato
Department of Cardiology, Matsue Red Cross Hospital
Hiroshi Miura
Department of Pathology, Matsue Red Cross Hospital
Katsumi Inoue
Department of Cardiology, Kurashiki Central Hospital
Masakiyo Nobuyoshi
Department of Cardiology, Kokura Memorial Hospital

Keywords: Atherectomy, Drug-eluting stent, IVUS, Pathology, Restenosis

JOURNAL FREE ACCESS

2009 Volume 73 Issue 10 Pages 1969-1971

DOI https://doi.org/10.1253/circj.CJ-08-0354

View "Advance Publication" version (January 27, 2009).

Details

Abstract

Restenosis still occurs, even with the sirolimus-eluting stent (SES), and the precise mechanisms have not yet been elucidated. In the present case, focal in-stent stenosis was discovered on angiography 16 months after SES implantation. Intravascular ultrasound revealed an echolucent homogeneous zone, which has been termed "black hole". A sample of stenotic tissue retrieved by aspiration revealed neointimal hyperplasia, composed of proteoglycans and smooth muscle cells with scanty cellularity. Furthermore, infiltration of many macrophages and T lymphocytes coexisted in the restenotic tissue. These findings suggest that delayed healing is 1 of the mechanisms of SES restenosis. (Circ J 2009; 73: 1969-1971)

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