Author + information
- Received August 23, 2018
- Revision received September 7, 2018
- Accepted September 11, 2018
- Published online November 14, 2018.
- Nozomu Yukimitsu, MD,
- Hirofumi Hioki, MD∗ (, )
- Hiroyuki Kyono, MD, PhD,
- Fukuko Nagura, MD and
- Ken Kozuma, MD, PhD
- ↵∗Address for correspondence:
Dr. Hirofumi Hioki, Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan 1830003.
A 64-year old man who had hypertension, diabetes, and dyslipidemia was admitted to our hospital with worsening chest pain. He has undergone percutaneous coronary intervention (PCI) for placement of a bare-metal stent in the proximal left anterior descending coronary artery (LAD) 15 years ago. Urgent coronary angiography revealed in-stent restenosis at the proximal LAD (Figure 1), then ad hoc PCI was performed. Optical coherence tomography (OCT) pre-procedure revealed a “Baumkuchen-like” structure with triple layers according to the neointimal OCT signal pattern at the narrowed segment (Figure 1). Because a scoring balloon failed to dilate the lesion properly, rotational atherectomy was applied for lesion modification. After atherectomy, the lesion was fully expanded by noncompliant balloon followed by successful drug-eluting stent implantation. Follow-up angiography and OCT at 6 months revealed no angiographic restenosis and minimal neointimal hyperplasia.
Here, we report for the first time to our knowledge a case with multiple layers of intima and neoatherosclerosis, assessed by OCT, 15 years after PCI. Further investigation is warranted to verify whether this unique OCT finding will help us to elucidate the mechanism of neoatherosclerosis in metallic stents and to consider the appropriate strategy of revascularization, particularly in very late in-stent restenosis cases.
Dr. Kozuma has received lecture fees and unrestricted research funding from Abbott Vascular Japan.
- Received August 23, 2018.
- Revision received September 7, 2018.
- Accepted September 11, 2018.
- 2018 American College of Cardiology Foundation