Author + information
- Received June 16, 2017
- Accepted July 19, 2017
- Published online November 20, 2017.
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan
- ↵∗Address for correspondence:
Dr. Ju-Yi Chen OR Dr. Yi-Heng Li, Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, 138 Sheng-Li Road, Tainan 704, Taiwan.
A 65-year-old male patient was admitted due to unstable angina. The patient had received percutaneous coronary intervention with 2 overlapping Taxus paclitaxel-eluting stents (Boston Scientific, Natick, Massachusetts) (3.5 × 32 mm and 3.0 × 32 mm) for his left anterior descending coronary artery long lesion 7 years ago. Coronary angiography showed left anterior descending coronary artery total occlusion since the previous first stent (Figure 1A). After wiring and balloon pre-dilatation, we opened the lesion (Figure 1B) and used optical coherence tomography (OCT) (St. Jude, Westford, Massachusetts) to check the causes of in-stent restenosis (ISR) (Figure 1C). Three coexisting putative causes of ISR, including neointima proliferation (Figure 1C1), neoatherosclerosis (Figure 1C2), and delayed arterial healing with uncovered struts (Figure 1C3), were identified from OCT images. The OCT findings have implications for the underlying histopathology of ISR (1). Homogeneous optical property (arrows in Figure 1C1) usually results from neointimal smooth muscle cell proliferation. Lipid-rich neointima with diffusely bordered and signal-poor regions (arrowheads in Figure 1C2) in OCT image indicates neoatherosclerosis. The uncovered stent struts (asterisks in Figure 1C3) with delayed arterial healing is a common phenomenon in early-generation drug-eluting stents. Both neoatherosclerosis and delayed arterial healing increase the risk of very late stent thrombosis and ISR (2). Percutaneous coronary intervention was performed with stents to treat the Figure 1C1 and Figure 1C2 lesions. Prolonged dual antiplatelet therapy was used to cover the delayed arterial healing.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 16, 2017.
- Accepted July 19, 2017.
- 2017 American College of Cardiology Foundation