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.

中文翻译：

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人体急性和慢性股骨支架的病理学和多模态成像。

目的本研究的目的是全面评估有症状的动脉粥样硬化患者急，慢性股骨支架置入术的病理，并使用包括微型计算机断层摄影在内的多模态成像来了解支架衰竭的原因。背景技术尽管已经对冠状动脉支架置入术的病理学进行了深入研究，但对下肢股骨支架置入术的病理学知之甚少。方法从10名具有周围动脉疾病病史的患者（中位年龄74岁；四分位间距[IQR]：66至82岁）中获得十二个在手术（n = 10）和尸检（n = 2）时去除的带支架的股骨病变。严重肢体缺血7例（男7例，女3例）。所有标本均接受了放射线照相，微型计算机断层扫描和组织学评估。结果中位植入时间为150天（IQR：30至365天），中位支架直径为5.90 mm（IQR：5.44至7.16 mm），中位支架长度为39.5 mm（IQR：27至107.5 mm） 。在12个带支架的病变中，有2个带药物洗脱支架，有10个带裸金属支架。在12个病变中的8个中观察到SF。SF的主要原因是急性血栓形成（6/8），但原因多种多样（愈合缓慢，支架扩张不足，假管腔支架置入和骨折），还有2例再狭窄。显微计算机断层扫描观察3例支架骨折。两种植入药物的支架植入时间均超过1年，均显示出愈合延迟，并伴有周向性周围支架纤维蛋白沉积和SF。结论该组织学研究是首次检查SF的病理原因。支架血栓形成是SF的主要原因。