Author + information
- Received March 14, 2017
- Revision received March 30, 2017
- Accepted April 6, 2017
- Published online June 28, 2017.
- Kenta Ohmure, MDa,
- Satoshi Yoshino, MDa,b,∗ (, )
- Daichi Fukumoto, MDa,
- Hirokazu Shimono, MDa,
- Hiroyuki Tabata, MDa,
- Yoshihiro Uchikado, MDa,
- Shigeki Tateishi, MDa and
- Mitsuru Ohishi, MDb
- aDepartment of Cardiology, Izumi Regional Medical Center, Kagoshima, Japan
- bDepartment of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
- ↵∗Address for correspondence:
Dr. Satoshi Yoshino, Izumi Regional Medical Center, Department of Cardiology, 4513, Akasegawa, Akune, Kagoshima 899-1611, Japan.
A 69-year-old man with effort angina pectoris previously underwent a total of 4 drug-eluting stent implantations in the left main trunk (LMT) to left anterior descending coronary artery (LAD), and a biolimus A9–eluting stent (BES) was deployed in the LMT. He was referred to our hospital for follow-up coronary angiography. Initial angiography of the LAD revealed no significant stenosis (Figure 1A), but subsequent angiography revealed slow flow. The first optical coherence tomographic examination was performed from LAD to LMT to determine the cause of slow flow. Three drug-eluting stents were implanted (Figure 1C), and their struts were covered well by neointima without thrombosis, erosion, or ulceration. Subsequent angiography demonstrated pooling of contrast media at the LMT (Figure 1B). Coronary dissection was suspected and expanded by our catheter operation, depending on the patient’s deep breathing. Intravascular ultrasound examination was not able to show the range of dissection and flap (Figure 1D), but the second optical coherence tomographic study showed intrastent neointimal dissection at the LMT without reaching the LAD (Figures 1E to 1G). The flap thickness was 60 to 100 μm (Figure 1F). A BES was deployed successfully to cover neointimal dissection in the BES, and final angiography showed good flow. Optical coherence tomographic findings revealed that the BES-in-BES covered the dissection well, and follow-up angiography showed good patency.
There are few reports of in-stent catheter-induced neointimal dissection. Optical coherence tomography was useful to confirm the range of neointimal dissection.
A portion of this study was reported at the 24th Annual Meeting of the Japanese Association of Cardiovascular Intervention and Therapeutics. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 14, 2017.
- Revision received March 30, 2017.
- Accepted April 6, 2017.
- 2017 American College of Cardiology Foundation