Korean Circ J.  2011 Nov;41(11):671-673. 10.4070/kcj.2011.41.11.671.

A Case of In-Stent Neointimal Plaque Rupture 10 Years After Bare Metal Stent Implantation: Intravascular Ultrasound and Optical Coherence Tomographic Findings

• Yoon HJ
• Hur SH
• Kim SK
• Kim H
• Park HS
• Cho YK
• Nam CW
• Kim YN
• Kim KB

• KMID: 2225076
• DOI: http://doi.org/10.4070/kcj.2011.41.11.671

Abstract

Neointimal hyperplasia mainly develops within several months of coronary stent deployment, after which it stabilizes. Although it was widely accepted, particularly during the bare-metal stent (BMS) era, that in-stent restenosis (ISR) generally does not present as an acute coronary syndrome (ACS), but rather as a gradual recurrence of angina symptoms, recent data have shown that a substantial number of patients with ISR present as ACS. There has also been consistent postmortem evidence of plaque rupture secondary to atherosclerotic change within the neointima of a BMS. We report here a case of ACS in which intravascular ultrasound and optical coherent tomographic assessments revealed neointimal atherosclerotic change and ruptured plaque 10 years after BMS deployment.

Keyword

Coronary restenosis; Stents; Neointima; Ultrasonography; Tomography

MeSH Terms

Acute Coronary Syndrome
Coronary Restenosis
Humans
Hyperplasia
Neointima
Recurrence
Rupture
Stents

Figure

• 

  Fig. 1 Coronary angiogram (upper panel), intravascular ultrasound (middle panel) and optical coherence tomography (lower panel) images of the in-stent restenosis site in the proximal left anterior descending artery. A: in comparisons of IVUS and OCT images in the corresponding site, an atherosclerotic plaque extending from 12 to 5 o'clock contains regions consistent with fibrous tissue, and a homogenous signal-poor lesion possible representing lipid core with thin cap fibrous atheroma (TFCA) was clearly shown in OCT (arrow). Although this fibrous atheromatous lesion was also apparent in the IVUS image from the same site, it was difficult to identify the presence of TFCA and lipid core. The minimal cap thickness at the region measured 60 m by OCT. B: immediately proximal to the ruptured plaque, the OCT image showed multiple disrupted intimal flaps and a subtle ulcerated palque (arrow) that was not clearly seen in the corresponding IVUS image. C: an obvious intimal rupture (arrow) with large cavitary change (*) was also clearly identified by OCT compard with corresponding IVUS image.

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