Yonsei Med J.  2011 Nov;52(6):1028-1030. 10.3349/ymj.2011.52.6.1028.

A Newly Formed and Ruptured Atheromatous Plaque within Neointima after Drug-Eluting Stent Implantation: 2-Year Follow-Up Intravascular Ultrasound and Optical Coherence Tomography Studies

• Oh CM
• Moon J
• Yu HT
• Jang JY
• Kim JS
• Ko YG
• Choi D
• Jang Y
• Hong MK

• KMID: 1058827
• DOI: http://doi.org/10.3349/ymj.2011.52.6.1028

Abstract

Late stent thrombosis (LST) which is a life threatening complication has emerged as a serious problem of drug-eluting stents (DES). Several studies have suggested that incomplete neointimal coverage of stent struts contributes to LST. Progressive atherosclerosis within the neointima is an another possible cause of LST, but this phenomenon has seldom been reported in DES. We present a case of LST following DES implantation after a period of 28 months due to ruptured atheromatous plaque, despite complete neointimal coverage of stent struts proven by optical coherence tomography.

Keyword

Drug-eluting stents; thrombosis; optical coherence tomography

MeSH Terms

*Angioplasty, Balloon, Coronary
Coronary Angiography
*Drug-Eluting Stents
Humans
Male
Middle Aged
Neointima/*pathology/ultrasonography
Thrombosis/pathology/ultrasonography
Tomography, Optical Coherence/*methods
Ultrasonography, Interventional/*methods

Figure

• 

  Fig. 1 Initial coronary angiogram of the RCA. (A) Coronary angiogram shows significant luminal narrowing at the distal RCA. (B) After stent implantation, there is a minimal residual stenosis. RCA, right coronary artery.

• 

  Fig. 2 Coronary angiogram and OCT findings at 12-month follow-up. (A)Coronary angiogram shows no restenosis in the stented segment. (B, C and D)The OCT shows complete neointimal coverage of stent struts. OCT, optical coherence tomography.

• 

  Fig. 3 (A) The 2nd follow-up angiogram at 28 months after stent implantation shows abnormal contrast filling in a previously implanted stent (see arrow). (B, C and D) IVUS and OCT images reveal newly formed and ruptured atheromatous plaque within neointima. Arrowheads indicate stent strut. IVUS , intravascular ultrasound; OCT, optical coherence tomography.

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