Pathological analysis of a case with peri-stent contrast staining after BMS implantation

Publication date: Available online 9 September 2016 Source:Journal of Cardiology Cases Author(s): Masao Imai, Atsuo Fukuda, Nobuhide Miyamoto, Hidenori Sako, Takeshi Kimura, Katsumi Inoue A 68-year-old female underwent bare-metal stent (BMS) implantation in the right coronary artery (RCA) for ST-segment elevation myocardial infarction. Recurrent refractory restenosis with peri-stent contrast staining (PSS) formation was observed in the stented lesion at follow-up angiography at 7, 11, and 14 months after the index stent implantation. After 2 repeated interventions, this patient was referred to coronary artery bypass grafting due to occlusion of RCA and progression of proximal left anterior descending coronary artery lesion at 15 months after stent implantation. Pathologic examination of the surgically resected specimen of stented RCA segment revealed total occlusion with dense fibrous collagenous tissue and significant inflammatory cell infiltration including scattered eosinophils. Extensive loss of medial smooth muscle layer was observed in the vessel wall, which was likely to be the cause of PSS. In the course of treatment, this patient was found to have chromium allergy with positive patch test. Allergic reactions to chromium released from the stent might be one of the triggering mechanisms for in-stent restenosis and PSS after BMS implantation. <Learning objective: Peri-stent contrast staining (PSS) was an abnormal angiographic finding suggesting presence o...
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research