Endothelialization of a Venous Stent at 1-month Post-Implantation: First in Human Angioscopic Assessment

J INVASIVE CARDIOL 2020;32(9):E248. 

Key words: angioscopy, endothelializaton, neointimal coverage, venous intervention, venous stent

Iliofemoral venous obstruction causes post-thrombotic syndrome, which leads to chronic leg swelling, claudication, leg ulcers, and impaired quality of life. Endovenous intervention has gradually adapted to treat iliofemoral stenosis or occlusion in the current clinical settings. The optimal strategy for antithrombotic therapy after venous stenting remains unclear due to lack of evidence. Generally, clinicians prescribe anticoagulants and/or antiplatelet therapy for 3-12 months or lifelong according to their preference. One ovine iliac vein model showed complete or almost complete endothelial cell coverage on the surface of stents at 56 and 180 days after stenting. To our knowledge, no in vivo study has presented the images of endothelialization after venous stenting in human. Here, we investigated endothelialization on a venous stent deployed in the left common iliac vein using angioscopy (Visible; Fiber Tech). The method of angioscopy was described elsewhere. 

A 77-year-old woman was referred to our hospital with prominent swelling in the left leg. She was diagnosed as having iliofemoral vein obstruction caused by acute thrombosis and iliac vein compression. After the catheter-directed thrombolysis with urokinase 360,000 IU/day for 3 days, venography depicted the obstruction at the iliac vein compression (Figure 1A) and intravascular ultrasound showed extreme narrowing with hyperechoic spur (Figure 1B; Video 1); thus, a 12 x 60 mm, self-expandable, metallic Smart stent (Cordis) was deployed. Her venous flow improved (Figure C). Follow-up angioscopy 1 month later showed neoendothelialization had started on most surfaces of the stent (Figure 1D; Video 2). This is the first report to evaluate endothelialization in vivo; the evidence of endothelialization on the venous stent in the early phase suggests that antithrombotic therapy could be stopped in some patients with high risk of bleeding in the chronic phase.

View the Supplemental Videos Here

From the Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted December 23, 2019.

Address for correspondence: Yasuhiro Tanabe, MD, PhD, Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki-City, Kanagawa 216-8511, Japan. Email: y-tanabe@muj.biglobe.ne.jp