A cluster of black holes and multiple plaque ruptures on optical coherence tomography 13 years after bare-metal stent implantation

Abstract

0167-5273/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2010.10.100 was readmitted for coronary angiography because of a relapse of angina symptoms. Coronary angiography showed severe in-stent restenosis with ulcer-like formation (Fig. 1). The finding of neointimal hyperplasia was observed on optical coherence tomography (OCT) (Fig. 2). Lipid-laden intima and white thrombus were observed in the distal part of the stent (Fig. 2B and C). OCT also revealed a “honeycomb structure” that had 3 cavities (Fig. 2D) and a cluster of “black holes” that had multiple small vesicular or tubular structures and were present in more than 3 consecutive frames in the midportion of the stent (Fig. 2E). All 3 compartments of the honeycomb structure between the vessel lumen and stent struts demonstrated plaque rupture. Prati et al. demonstrated that thin black holes on OCT are likely due to plaque angiogenesis [1]. However, it remains unclear