Author + information
- Received February 7, 2015
- Accepted February 26, 2015
- Published online July 1, 2015.
- Rika Kawakami, MD∗,
- Hiroyuki Hao, MD∗∗ (, )
- Yaemi Takagi, MD∗,
- Akiko Fujino, MD∗,
- Yasu-aki Tsuchida, MD∗,
- Takahiro Imanaka, MD†,
- Kenichi Fujii, MD† and
- Seiichi Hirota, MD∗
- ∗Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
- †Division of Coronary Heart Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
- ↵∗Reprint requests and correspondence:
Dr. Hiroyuki Hao, Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
A 70-year-old woman was admitted to our hospital due to cardiogenic shock and died of heart failure 1 day after admission. She had a 12-year history of hemodialysis. Biodegradable-polymer biolimus-eluting stent (NOBORI, Terumo Corporation, Tokyo, Japan) was implanted in the left anterior descending artery 2 months before. An autopsy was performed, and ex vivo intravascular ultrasound (Terumo Corp.), optical frequency domain imaging (Terumo Corp.), and coronary angioscopy (FiberTech, Tokyo, Japan) were examined.
Intravascular ultrasound, optical frequency domain imaging, and coronary angioscopy demonstrated a hypoechoic mass (Figure 1A), a high backscattering protruding mass with signal attenuation (Figure 1B), and a yellowish protrusion with uneven strut expansion (Figure 1C), respectively, at the stent-implanted region. Neointima coverage was minimal, and struts were visible. Histology demonstrated a large calcified nodule (CN) (1) underneath the stent struts (Figure 2A). A healthy vessel wall was stretched with medial necrosis and nearly ruptured by stent implantation (Figure 2B). Most of the stent struts were covered by minimal neointima with loose extracellular matrix (Figure 2C) and scattered α-smooth muscle actin-positive spindle-shaped cells (Figure 2D).
The target lesion calcification is an important determinant of the expansion of stent (2). A CN hardly expands by the tensile strength of stent deployment. In fact, the stent area was insufficient in the present case. Furthermore, a healthy vessel wall might be overstretched and rupture during the intervention. We need to exercise every precaution for an intervention of a CN.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 7, 2015.
- Accepted February 26, 2015.
- 2015 American College of Cardiology Foundation