Acute interstitial pneumonitis after implantation of paclitaxel-eluting stents: A report of two fatal cases

Paclitaxel is an anti-neoplastic agent widely used as a coating substance for coronary stents to reduce the rate of restenosis. Although the release rate of paclitaxel from stents is quite slow and the dose of paclitaxel is extremely small, long-term safety and avoidance of potentially lethal pulmonary damage is not well established. We report two cases of paclitaxel-eluting stent implantation in ischemic heart disease patients who developed acute interstitial pneumonitis a few days afterward, and who succumbed to fatal respiratory dysfunction despite corticosteroid therapy. Based upon the clinical course and autopsy findings in these two patients, paclitaxel eluted from the stent may have played a causal role in the development of acute interstitial pneumonitis. Physicians should bear in mind that paclitaxel has the potential of causing acute interstitial pneumonitis not only when used for anti-neoplastic therapy, but also following stent implantation, where the objective is to inhibit coronary neointimal proliferation. (C) 2009 Elsevier Ireland Ltd. All rights reserved.