Author + information
- Received July 5, 2012
- Accepted August 2, 2012
- Published online April 1, 2013.
- Yusuke Fujino, MD⁎,
- Guilherme F. Attizzani, MD⁎,
- Sunao Nakamura, MD, PhD†,
- 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, 11100 Euclid Avenue, Lakeside 3113, Cleveland, Ohio 44106
A 57-year-old female underwent successful percutaneous coronary intervention (PCI) of the mid-distal left main coronary artery and the mid left anterior descending artery with 2 non-overlapping sirolimus-eluting stents with durable polymer (SES). Three years later, the patient was evaluated with multislice computed tomography due to recurrent chest pain. Low-density areas without calcification around the previously implanted SES were revealed (Fig. 1). Angiography showed important dilation of coronary artery tree in the stented regions, whereas intravascular ultrasound revealed positive remodeling (Fig. 2).
Frequency-domain optical coherence tomography (FD-OCT) assessment exhibited vessel wall dilation as well as covered/apposed and uncovered/malapposed stent struts, which were also demonstrated in the 3-dimensional reconstruction (Fig. 2). Although multislice computed tomography and intravascular ultrasound were able to depict coronary artery aneurysm formation secondary to SES implantation, they were not able to adequately characterize stent-vessel interactions, such as stent strut coverage, and to rule out the presence of thrombus. Conversely, FD-OCT clearly determined coverage and apposition status of stent struts as well as vessel wall dilation and the absence of thrombus. Complementary information on vessel remodelling can be obtained by either MSCT or IVUS.
The formation of coronary artery aneurysm induced by drug-eluting stent implantation is a rare phenomenon that might increase the risk of stent thrombosis (1). Frequency-domain OCT might play an important role in the evaluation of this pathological phenomenon, because it provides high spatial resolution coupled with image acquisition in a blood-free environment, enabling precise delineation of lumen and stent (2).
Dr. Attizzani has received consultant honoraria from St. Jude Medical. Dr. Costa is on the Speakers' Bureaus of and is a consultant for Daiichi-Sankyo, St. Jude Medical, Boston Scientific Corporation, Sanofi-Aventis, Eli Lilly, and Medtronic; and is on the Speakers' Bureaus of and is a member of the Scientific Advisory Boards for Abbott, Cordis, St. Jude Medical, and Scitech. 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.
- Accepted August 2, 2012.
- American College of Cardiology Foundation