Generalized arteriosclerosis and stent implantation. An epicritic report

In a comprehensive demonstration we report on the long-term course of the first patient in the world to receive a vascular balloon expandable endoprosthesis (Palmaz iliac vascular stent). Iliac occlusive disease became apparent again several years after an initially successful regular balloon angioplasty of the left common iliac artery. After successful stent implantation the patient then remained completely asymptomatic over unlimited walking distance during the follow-up of 29 months, after which he died of a myocardial reinfarction. While repeat catheter angiography showed excellent incorporation of the metal stent, arteriosclerotic disease was found to have progressed in the distal abdominal aorta. Thus, the patient died of a typical complication of peripheral vascular disease, naturally reflecting the generalized character which cannot be affected by local treatment modalities. While microscopic evaluation revealed 'ideal' biocompatibility of the device, portraying its high functional efficacy, the natural course of the patient reflects the purely symptomatic character of the improvement. An interesting finding was the homogeneous architecture of the neointima that developed on top of the stent. While large parts of the adjacent vessel wall had undergone significant arteriosclerotic changes this was not found in the neointima, which was made up exclusively of mature fibrocollagenous tissue.