In-stent Neoatherosclerosis 10 Years after Bare Metal Stent Implantation Observed by Coronary Angioscopy

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Previous studies showed that intimal atherosclerotic change over stent was found, which is the so-called in-stent neoatherosclerosis. Previous studies with coronary imaging devices such as intravascular ultrasound and optical coherence tomography demonstrated that in-stent neoatherosclerosis was observed several years after stent implantation. However, a few cases of in-stent neoatherosclerosis observed by coronary angioscopy (CAS) have been reported. A 50-year-old male was treated with bare metal stent (BMS) implantation at proximal right coronary artery (RCA) for first acute myocardial infarction (AMI). Ten years later, he suffered from a second AMI. Emergency coronary angiography showed a de novo lesion of severe stenosis at mid RCA and mild restenosis of BMS which had been implanted at proximal RCA 10 years ago. Severe stenosis at mid RCA seemed to be the culprit lesion. At mid RCA of the culprit lesions, CAS showed that red thrombus was observed on yellow plaque without plaque rupture. Intravascular ultrasound (IVUS) showed luminal narrowing with attenuated plaque, with neither plaque rupture nor thrombus. Plaque erosion was the mechanism of occurrence of acute coronary syndrome. At mid and proximal portions in BMS, several yellow plaques were observed whose morphology was complex with irregular surface. Red thrombus stuck on yellow plaque stickily, not sticking out of the lumen. In BMS segment, IVUS showed neointimal proliferation with dissection over BMS, which part was low echoic plaque. CAS revealed yellow plaque and silent stent thrombus in the BMS segment implanted 10 years ago. These findings suggested neoatherosclerosis with high thrombogenity formed in neointima after BMS implantation.

Journal

  • Angioscopy

    Angioscopy 1 (1), 32-34, 2015

    Japanese Association of Cardioangioscopy

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