Pathological findings of late stent thrombosis after paclitaxel-eluting stent implantation for superficial femoral artery disease

AbstractA 76-year-old man presented with right critical limb ischemia. An angiography revealed right SFA occlusion. Therefore, two paclitaxel-eluting stents (Zilver PTXs 6.0mm×120mm stents; Cook Medical, Bloomington, Indiana) were placed, which promoted good blood flow. Follow-up angiography at 6 months also showed no restenosis. However, 10 months later, the patient suddenly visited with acute-onset pain in the right leg. Computed tomography showed the acute occlusion at the stented SFA. Eventually, above-knee amputation was performed due to the poor general condition and progressive limb ischemia. As the pathological finding, heterogeneous neointima formation at the stented site was mainly found. Although neointimal layer consisting of smooth muscle cell (SMC) was partly observed, necrotic tissue was evident in the remaining portion. At the necrotic tissue site, the majority of the components of the material covered by the stent strut were fibrin deposits. The findings of regenerative endothelial cells were not observed at the luminal surface. Nuclei of medial SMCs were also lost between the arterial media and the stent strut.Late stent thrombosis after paclitaxel-eluting stenting for SFA lesion has not been sufficiently evaluated. Here, we report a case of late stent thrombosis with a review including pathological findings.<Learning objective: We reported that a 76-year-old man received paclitaxel-eluting stent for femoropopliteal disease. Ten months later, stent thrombosis was occurred and above-knee amputation was performed. As the pathological finding, heterogeneous neointima formation was mainly found and the regenerative endothelial cells were not observed. Our report suggested that delayed healing and uncovered strut caused by paclitaxel-exposure resulted in late stent thrombosis.

CLS in colorectal carcinoma

BACKGROUND. Both serum elevation of C-reactive protein (CRP) and reduction of lymphocyte in the peripheral blood has been known as indicator for malignant potential of human tumors. METHODS. Whether newly devised CLS (CRP/Lymphocyte Score), based on combined data of serum elevation of CRP and of lymphocyte percentage in the peripheral blood can be an indicator for progressive potential in colorectal carcinoma was examined in 280 cases who had been surgically treated. RESULTS. Significant difference in survival was observed both between CLS 0 and 1 and between CLS 1 and 2, in both cases when analyzed among whole patients and patient who had been treated with curative resection. Multivariate analysis among patients who had been treated with curative resection demonstrated that CLS (P < 0.0001), histologic type (P = 0.0003), and tumor stage (P = 0.039) were factors independently associated with worse prognosis of the patients. CONCLUSIONS. Newly devised criteria CLS could be an independent prognostic indicator in colorectal carcinoma and would be utilized as a helpful information

Prognostic Criteria in Gastric Carcinoma

Purpose. The aim of this study was to develop prognostic criteria based on the combination of nodal metastasis and preoperative elevation of serum C-reactive protein (CRP) for patients with gastric carcinoma that have been treated with curative resection. Methods. Three hundred and twenty patients with gastric carcinoma who had been treated with curative resection were enrolled. One point was provided for each incidence of nodal metastasis and preoperative elevation of serum CRP and we examined whether this cumulative score system could provide a strict stratification of survival. Results. Significant differences regarding survival were observed both between patients with scores of 0 and 1 (P < 0.0001) and between patients with scores of 1 and 2 (P < 0.0001). Multivariate analysis showed that the cumulative score (P = 0.0003) and the depth of the tumor (P = 0.016) were independent prognostic indicators. Conclusions. Criteria for the prediction of prognosis in gastric carcinoma treated with curative resection based on tumor-related and host-related factors could provide a strict stratification

Acute limb ischemia of the lower extremity associated with left upper lobe surgery for primary lung cancer

Thrombosis formation in the pulmonary vein stump after pulmonary lobectomy has recently been reported to be an extremely rare cause of arterial embolism. We herein report the first case series of acute limb ischemia encountered after video-assisted thoracoscopic left upper lobectomy or left upper division segmentectomy for primary lung cancer. The patients underwent embolectomy, and their perioperative courses were uneventful. It should be recognized that the pulmonary vein stump can cause acute limb ischemia after pulmonary lobectomy. Key words: Multidetector computed tomography, Perioperative, Left upper lobectom

Superficial temporal artery aneurysm associated with immunoglobulin G4-related disease

A 68-year-old man was admitted because of a pulsatile mass and pain in the left temporal region, and computed tomography demonstrated the superficial temporal artery aneurysm. He underwent aneurysmectomy, and pathologic investigation revealed marked thickness of the adventitia with substantial plasmacyte infiltration. On immunoglobulin G4 (IgG4) immunohistochemistry, IgG4-positive lymphocytes were scattered in the adventitia, and biochemical tests revealed elevation of IgG4 (200 mg/dL). The case satisfied the criteria for both giant cell arteritis and IgG4-related disease (IgG4-RD). This case report suggested that IgG4-RD can occur in the superficial temporal artery and that IgG4-RD may partially overlap with a subtype of giant cell arteritis

ステントグラフトに工夫を要した高度屈曲かつ大口径ネックを伴う腹部大動脈瘤の一例

This report presents the case of an abdominal aortic aneurysm (AAA), in which the aortic neck was severely angulated. Furthermore, there was moderate stenosis and a severe angle with calcification of the suprarenal aorta. EVAR was performed with a commercial Zenith stent-graft, with a slight modification, because an open aneurysm repair was risky in general condition. No complications occurred during the follow-up period.症例は86歳，女性．腎動脈下に55mm，紡錘状の腹部大動脈瘤を認めた．高齢，冠動脈ステント後かつ慢性心不全のため開腹人工血管置換術は，周術期合併症や手術死亡の危険性が高いと判断した．動脈瘤の中枢頸部は径30mm，長さ15mm，屈曲高度を伴い，かつ腎動脈直上は高度屈曲，石灰化狭窄を認め，解剖学的にはステントグラフトの適応外であった．大口径のステントグラフト(ゼニス36mm)を用いれば，中枢頸部の圧着は可能であるが，腎動脈直上の高度屈曲，石灰化狭窄のため腎動脈上ステントが展開しない恐れがあった．そこで我々は，バックテーブルでステントグラフトを展開し，腎動脈上ステントを除去した後に，ステントグラフトをシース内に再格納し，腎動脈上ステントを除去したステントグラフトを腎動脈直下に展開することによって，動脈瘤治療の技術的成功を得た．現在までステントグラフトの脱落やエンドリークは認めず，術後経過は良好であった．ステントグラフトを工夫することにより，開腹人工血管置換術のハイリスク症例かつ屈曲高度を伴う解剖学的ステントグラフト適応外症例において，一つの治療オプションとなる可能性がある