Neoatherosclerosis in Very Late Stenosis of Bare Metal Stent by Optical Coherence Tomography.

Samer Mowakeaa,Aline Iskandar,Nikolaos Kakouros

doi:10.1155/2016/1652065

Samer Mowakeaa, Aline Iskandar + Show 1 more

Open Access

https://doi.org/10.1155/2016/1652065

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Abstract

Bare metal stents (BMS) continue to be widely used in patients with coronary artery disease undergoing percutaneous revascularization. Progressive luminal renarrowing has been reported late after BMS implantation resulting in a significant rate of stent failure events. We present a case of very late BMS failure due to in-stent restenosis where optical coherence tomography (OCT) was used to demonstrate neoatherosclerosis as the underlying mechanism. We provide a brief review of neoatherosclerosis and showcase salient features on OCT evaluation.

Highlights

Despite the high rates of drug-eluting stent utilization in the United States [1], bare metal stents (BMS) continue to be widely used in patients with coronary artery disease undergoing percutaneous revascularization (15% of the patients in 2014) [2]
Coronary angiography demonstrated a critical stenosis within the prior stent in the mid-RCA (Figure 1(a)) that was occlusive to flow when crossed with a Dragonfly Duo Optical coherence tomography (OCT) catheter
The present study illustrates a case of very late stent failure due to severe in-stent restenosis (ISR) causing progressive exertional angina and a type 2 myocardial infarction

Summary

Introduction

Despite the high rates of drug-eluting stent utilization in the United States [1], bare metal stents (BMS) continue to be widely used in patients with coronary artery disease undergoing percutaneous revascularization (15% of the patients in 2014) [2]. Very late stent failure, occurring >10 years after initial implantation, is not an infrequent finding with bare metal stents (BMS) [3]. Multiple factors contributing to late stent failure have been proposed, de novo development of atherosclerosis within the neointima has been identified as a major cause [5, 6]. OCT can be a valuable tool used to identify the mechanism of stent failure by demonstrating distinct tissue characteristics

Case Report

Discussion