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Repeated occurrence of slow flow phenomenon during and late after sirolimus-eluting stent implantation.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Sakata, Kenji Namura, Masanobu Takagi, Toshimitsu Tama, Naoto Inoki, Isao Terai, Hidenobu Horita, Yuki Ikeda, Masatoshi Yamagishi, Masakazu
Description	Country affiliation: Japan Author Affiliation: Sakata K ( Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan.)
Abstract	A 78-year-old man with unstable angina showed 90% stenosis in the proximal left anterior descending artery. Pre-procedural intravascular ultrasound revealed ruptured plaque and attenuated plaque in the lesion. Under these conditions, two overlapping sirolimus-eluting stent (SES) implantation in this lesion resulted in slow flow which was recovered by intracoronary nitrates, nicorandil, and nitroprusside without further complications. When the patient showed up again 5 years later with recurrence of angina pectoris, angiography revealed a hazy ulcerated in-stent restenosis (ISR) at the site of the SES. Pre-procedural optical coherence tomography (OCT) imaging revealed multiple intimal ruptures, cavity formation behind the stent struts, a thin-cap fibroatheroma containing neointima surrounded by signal-poor, lipid-rich area in the proximal SES, suggesting the progression of neoatherosclerosis within SES. Importantly, there occurred slow flow again after balloon angioplasty for this lesion. We would suggest careful OCT examination is warranted to confirm development of neoatherosclerosis within the stent, and distal protection device should be considered to prevent slow flow phenomenon even in a patient with very late ISR.
File Format	HTM / HTML
ISSN	09108327
Issue Number	3
Volume Number	30
e-ISSN	16152573
Journal	Heart and Vessels
Language	English
Publisher	Springer
Publisher Date	2015-05-01
Publisher Place	Japan
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Cardiology Angioplasty, Balloon, Coronary Instrumentation Cardiovascular Agents Administration & Dosage Coronary Restenosis Therapy Coronary Stenosis Drug-eluting Stents No-reflow Phenomenon Etiology Sirolimus Aged Adverse Effects Coronary Angiography Coronary Circulation Diagnosis Physiopathology Denture, Partial, Temporary Humans Male Recurrence Retreatment Time Factors Tomography, Optical Coherence Treatment Outcome Ultrasonography, Interventional Case Reports Journal Article
Content Type	Text
Resource Type	Case study Article
Subject	Cardiology and Cardiovascular Medicine

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