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A Case of Thrombus-related Early Focal In-stent Restenosis after Everolimus-eluting Stent Implantation
| Content Provider | Semantic Scholar |
|---|---|
| Author | Yamazaki, Hiroshi Ishibashi, Yuki Tanabe, Yasuhiro Akashi, Yoshihiro J. |
| Copyright Year | 2018 |
| Abstract | We obtained informed consent and this case report was approved by an ethics committee. A 78-year-old man, a current smoker, with coronary risk factors of hypertension and dyslipidemia presented to the department with angina pectoris. Elective coronary angiography (CAG) demonstrated a severely calcified stenotic lesion at the mid-right coronary artery (mid-RCA). The lesions were successfully treated by three everolimus-eluting stents (EESs) (3.5 × 18, 3.5 × 15, and 3.0 × 15 mm) (Xience; Abbott Vascular, Redwood City, CA, USA) after percutaneous transluminal coronary rotational atherectomy (PTCRA) (Fig. 1). The patient was prescribed aspirin 100 mg and clopidogrel 75 mg after PCI. Quantitative CAG showed that the percentage of diameter stenosis and minimal diameter stenosis were improved from 62% and 1.34 mm to 38% and 2.54 mm after the treatment, respectively. Angiography and intravascular ultrasound images confirmed a well-expanded stent. Routine follow-up CAG after 9 months of the first index procedure confirmed high-grade focal restenosis with a contrast filling transparency at the site of severe calcification in the midRCA. The present case was thus assumed as a focal, asymptomatic, and thrombi-related restenosis pattern in the EESs. Optical coherence tomography (OCT ; ILUMIENTM OCT Imaging System, St Jude Medical, Japan) showed residual thrombus overlying the stent struts. Coronary angioscopy showed white and red mixed-thrombus, protrusion of yellow plaque, and stent struts uncovered by neointima. The lesion was treated with a cutting balloon (Lacross NSE catheter 3.0 × 15 mm, Goodman, Co, Lt.) after manual aspiration (Thrombuster III GR Kaneka, Osaka, Japan) guided by OCT and angioscopy (Fig. 2). Although repeat CAG 9 months after the second index procedure showed no significant stenosis at the restenotic lesion, angioscopy showed uncovered stent strut at the site of stent overlapping (Fig. 3). |
| Starting Page | 187 |
| Ending Page | 189 |
| Page Count | 3 |
| File Format | PDF HTM / HTML |
| DOI | 10.7793/jcoron.24.17-00007 |
| Volume Number | 24 |
| Alternate Webpage(s) | https://www.jstage.jst.go.jp/article/jcoron/advpub/0/advpub_24.17-00007/_pdf |
| Alternate Webpage(s) | https://doi.org/10.7793/jcoron.24.17-00007 |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
