Five-year histological evaluation of paclitaxel-eluting stent for an infrapopliteal lesion: a case report

Background: The long-term vascular response to paclitaxel-eluting stents (PESs) in infrapopliteal (IP) lesions remains histologically uncharacterized. Case summary: A 78-year-old woman with chronic limb-threatening ischaemia underwent implantation of two overlapping paclitaxel-eluting stents from the tibioperoneal trunk to the peroneal artery for an ischaemic ulcer. Multimodality follow-up imaging was obtained at both 3 and 5 years, including optical frequency domain imaging (OFDI) and angioscopy performed immediately before amputation. At 3 years, OFDI and angioscopy demonstrated uncovered struts with adherent thrombus. At 5 years, OFDI and angioscopy showed mature neointima over the proximal and distal segments but persistent fibrin-coated, uncovered struts within the 40-mm overlap. Progressive ischaemia culminated in below-the-knee amputation, permitting stent explantation. Histopathology confirmed proteoglycan-rich neointima at the non-overlapped segments and delayed healing with fibrin deposition and uncovered struts confined to the overlap. Conclusion: The 5-year histological evaluation of the PES revealed paclitaxel-related impaired endothelialization in IP lesions.