Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent should we be cautious?
Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent should we be cautious?
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DOI：
10.1161/01.cir.0000116202.41966.d4
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发表时间：
2004-02-17
期刊：
影响因子：
37.8
通讯作者：
Kolodgie, FD
中科院分区：
文献类型：
--
作者：
Virmani, R;Guagliumi, G;Kolodgie, FD
背景-美国食品和药物管理局最近发布了关于西罗莫司洗脱支架（Cypher）的亚急性血栓形成和超敏反应的警告。这些事件的原因和发病率尚未determined.Methods和结果-我们目前的调查结果，一名58岁的男子谁死于晚期支架血栓形成后18个月接受2 Cypher支架不稳定型心绞痛。尽管8个月时的血管造影和血管内超声结果表明没有新生内膜形成，但存在血管扩张。尸检显示支架的动脉段严重的局部超敏反应，主要由T淋巴细胞和嗜酸性粒细胞组成的aerosynthetic dilation.Conclusions -已知的药代动力学洗脱配置文件的Cypher支架和巨细胞和嗜酸性粒细胞包围的聚合物片段的存在表明，聚合物的反应可能会导致晚期支架血栓形成。建议对Cypher支架置入后血管扩大的患者进行仔细的长期随访。
Background - The US Food and Drug Administration recently issued a warning of subacute thrombosis and hypersensitivity reactions to sirolimus-eluting stents ( Cypher). The cause and incidence of these events have not been determined.Methods and Results - We present findings of a 58-year-old man who died of late stent thrombosis 18 months after receiving 2 Cypher stents for unstable angina. Although angiographic and intravascular ultrasound results at 8 months demonstrated the absence of neointimal formation, vessel enlargement was present. An autopsy showed aneurysmal dilation of the stented arterial segments with a severe localized hypersensitivity reaction consisting predominantly of T lymphocytes and eosinophils.Conclusions - The known pharmacokinetic elution profile of Cypher stents and the presence of polymer fragments surrounded by giant cells and eosinophils suggest that a reaction to the polymer may have caused late stent thrombosis. Careful long-term follow-up of patients with vessel enlargement after Cypher stent placement is recommended.