Yonsei Med J.  2012 Mar;53(2):450-453. 10.3349/ymj.2012.53.2.450.

Identification of Vulnerable Plaque in a Stented Coronary Segment 17 Years after Implantation Using Optical Coherence Tomography

• Yang JH
• Byeon K
• Gwon HC
• Park JE
• Song YB

• KMID: 1120218
• DOI: http://doi.org/10.3349/ymj.2012.53.2.450

Abstract

A patient presented with exertional chest pain two months prior to admission. Coronary angiography revealed a subocclusive stenosis within the boundaries of the stent. Optical coherence tomography showed remarkable intimal growth inside the stent, which demonstrated a heterogeneous appearance including low-intensity areas. These findings were congruent with the morphology of fibroatheroma in the native coronary artery and suggested that new atherosclerotic progression of the intima within the stent had occurred over 17 years following bare metal stent implantation. To the best of our knowledge, this is one of the most delayed instances of a bare metal stent restenosis described in the medical literature.

Keyword

Atherosclerosis; stent; percutaneous coronary intervention; restenosis

MeSH Terms

Aged
Angioplasty, Balloon, Coronary
Coronary Restenosis/*diagnosis
Female
Humans
Tomography, Optical Coherence/*methods

Figure

• 

  Fig. 1 (A) Baseline coronary angiography showing in-stent restenosis at the proximal segment of the left anterior descending (LAD) coronary artery (black arrow). (B) A 2.75×28 mm Promus element stent (Boston Scientific Corp., Natick, MA, USA) was placed successfully at 16 atmospheres within the previous stent of the LAD.

• 

  Fig. 2 (A) A thin-cap fibroatheroma assessed using optical coherence tomography (OCT) overlying a large lipid-rich plaque (1 to 5 o'clock position). The OCT shows the presence of lipid-rich intima as a signal-poor area (⋆); a bright reflective fibrous cap (red arrow) and stent struts (white arrowheads) are also observed. (B) OCT reveals a homogeneous high signal band at the inner luminal border in a more proximal segment within the BMS. Longitudinal OCT view shows layered appearance with inner high scattering and outer low scattering layer. BMS, bare metal stent.

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