Author + information
- Received July 5, 2012
- Revision received July 26, 2012
- Accepted August 2, 2012
- Published online February 1, 2013.
- Yusuke Fujino, MD⁎,†,
- Guilherme F. Attizzani, MD†,
- Sunao Nakamura, MD⁎,
- Marco A. Costa, MD, PhD† and
- Hiram G. Bezerra, MD, PhD†,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Hiram G. Bezerra, Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, 11100 Euclid Avenue, Lakeside 3113, Cleveland, Ohio 44106
A 60-year-old man with a history of chronic renal failure in hemodialysis was admitted due to angina symptoms. Coronary angiography showed an eccentric lesion of distal unprotected left main coronary artery involving the ostium of left anterior descending artery (Fig. 1A). Frequency-domain optical coherence tomography (FD-OCT) revealed a calcified plaque protruding to the lumen (Fig. 1-a). Rotational atherectomy with a 2.0-mm burr (Fig. 1-b) was conducted before the implantation of a 3.5 × 18 mm sirolimus-eluting stent at 12 atm., which was followed by intra-stent post-dilation with a noncompliant 4.0 × 12 mm balloon at 18 atm. (Fig. 1C, c).
The patient underwent 9-month follow-up coronary angiography that showed luminal loss (Fig. 1D). The FD-OCT imaging exhibited a constricted sirolimus-eluting stent (Fig. 1-d). Three-dimensional FD-OCT images revealed a well-expanded stent at baseline, whereas stent constriction was depicted in a highly calcified region at follow-up (Fig. 2).
Although a rare phenomenon, stent constriction might be responsible for target lesion failure (1). In the present case, FD-OCT images helped clarify the mechanisms that led to late luminal loss, demonstrating the longitudinal distribution of stent constriction, as well as its relationship with a highly calcified plaque, therefore playing an important role in treatment proposal.
Dr. Costa is on the Speakers' Bureaus of and is a consultant for Daiichi-Sankyo, St. Jude, Boston Scientific Corporation, Sanofi-Aventis, Eli Lilly, and Medtronic; he is also on the Speakers' Bureaus of and is a member of the Scientific Advisory Boards for Abbott, Cordis, St. Jude Medical, and Scitech. Dr. Attizzani has received consultant honoraria from St. Jude Medical. Dr. Bezerra has received honoraria grants from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 5, 2012.
- Revision received July 26, 2012.
- Accepted August 2, 2012.
- American College of Cardiology Foundation