Author + information
- Received September 25, 2009
- Revision received October 19, 2009
- Accepted October 29, 2009
- Published online April 1, 2010.
- Shinichi Furuichi, MD⁎ (, )
- Yoshifumi Sasamori, CE,
- Takeichi Yamaji, RT and
- Toshiya Satoh, MD
- ↵⁎Reprint requests and correspondence:
Dr. Shinichi Furuichi, Department of Cardiovascular Medicine, Cardiovascular Centre Hokkaido Ohno Hospital, 4-1-1-30 Nishino Nishi-ku, Sapporo 063-0034, Japan
A 76-year-old man with cardiac risk factors of hypertension and smoking was referred to our hospital for elective follow-up angiography, because he was due to undergo carotid artery stenting. Sirolimus-eluting stents had been implanted in the mid to proximal portion of the right coronary artery 3 years previously. Control angiography showed minimal neointimal proliferation inside the stents (Fig. 1A). Immediately after the first injection, the catheter pressure fell and the patient complained of chest pain. Further angiography demonstrated an occlusion of the stent with a radiolucent dissection flap inside the stent (Fig. 1B); consequently, we performed bail-out emergency angioplasty. After guidewire placement, Thrombolysis In Myocardial Infarction flow grade 3 was restored (Fig. 1C). To evaluate the cause of the occlusion, intravascular ultrasound was performed. Intravascular ultrasound with saline injection through the guiding catheter revealed a neointimal dissection flap inside the stent with a transiently compromised true lumen by the dissection flap (Fig. 1, Figs. 1a–1c and Online Video 1). The dissection flat originated only from within the stent and started from the proximal edge of the stent where the catheter tip had been positioned during the first injection. Another sirolimus-eluting stent was implanted to seal the entire dissection plane, and final angiography showed a good result (Fig. 1D).
For a supplementary video, please see the online version of this article.
- Received September 25, 2009.
- Revision received October 19, 2009.
- Accepted October 29, 2009.
- American College of Cardiology Foundation