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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Histopathological findings in a human carotid artery after stent implantation. Case report
Naoki Toma1, Satoshi Matsushima, Kenichi Murao
1Department of Neurosurgery, Mie University School of Medicine, Tsu, Japan.
Insights
Histopathological analysis of a stented carotid artery (CA) in an autopsy specimen revealed a stabilized neointima, indicating successful vessel healing. However, residual thrombus in the common CA suggests a potential future risk of embolism.
Area of Science:
- Vascular Surgery
- Cardiovascular Pathology
- Interventional Cardiology
Background:
- Carotid artery (CA) stent implantation has high technical success rates but its long-term effects on vessel wall morphology remain unclear.
- Understanding post-procedural CA morphology is crucial for assessing long-term safety and optimizing stent selection.
Observation:
- A human autopsy specimen of a stented CA, 8 months post-implantation, was analyzed using macroscopic, scanning electron microscopy, and histopathological methods.
- The specimen was from a 75-year-old male who underwent successful CA stent implantation for asymptomatic stenosis.
Findings:
- A stabilized neointima, positive for alpha-smooth muscle actin and collagen, with complete reendothelialization, was observed overlying the stent in the internal CA.
- Focal chronic inflammation persisted around the stent struts.
- Residual mural thrombus was present around the stent struts in the common CA, raising concerns for future distal embolism.
Implications:
- The findings support the potential for stabilized neointima formation after carotid artery stenting.
- The presence of residual thrombus highlights a potential risk factor that warrants further investigation.
- This case provides valuable morphological data for guiding appropriate carotid stent sizing and selection.
Abstract:
Despite the high technical success rates and the acceptable morbidity and mortality rates that are associated with carotid artery (CA) stent implantation, morphological changes in the vessel wall after this procedure are still unknown. The authors describe histopathological findings of the CA after stent implantation in a human autopsy specimen. A 75-year-old man with asymptomatic CA stenosis underwent successful CA stent implantation, but died 8 months afterward of complications surrounding treatment of a thoracic aortic artery aneurysm. The stented CA was isolated from the autopsy specimen and was analyzed macroscopically and with the aid of scanning electron microscopy and histopathological methods. Although there was focal persistence of a chronic inflammatory reaction around the stent struts, a stabilized neointima overlying the stent, which was principally composed of cells that stained positively for alpha-smooth muscle actin and collagen deposition with complete reendothelialization of the luminal surface, was confirmed in the internal CA. In contrast, residual mural thrombus around the stent struts in the common CA led to a concern about the potential risk for distal embolism in the future. The present case provides supportive evidence of stabilized neointima overlying the stent and valuable information regarding morphological characteristics useful for selecting a stent of an appropriate size.
