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Optical coherence tomography images of bell-shaped appearance in late sirolimus-eluting stent restenosis with extension of previous incomplete stent apposition.

ABSTRACT: Late adverse events including late stent thrombosis and late catch-up phenomenon after percutaneous coronary intervention have been a serious clinical problem in the drug-eluting stent era. Recently, peri-stent contrast staining, namely extension of incomplete stent apposition was reported following drug-eluting stent implantation. Here, we report a case of late incomplete stent apposition with late stent restenosis 3 years after sirolimus-eluting stent implantation. We evaluated this restenotic site by intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Though IVUS demonstrated irregular structure within stent at the stenotic site, OCT detected unusual bell-shaped image of late stent restenosis with extension of incomplete stent apposition.

SUBMITTER: Iguchi T

PROVIDER: S-EPMC6265391 | biostudies-literature | 2011 Dec

REPOSITORIES: biostudies-literature

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Project description:Given the limited salvage options for in-stent restenosis (ISR) of drug-eluting stents (DES), our high-volume cardiac catheterization laboratory has been performing intracoronary brachytherapy (ICBT) in patients with recurrent ISR of DES. This study analyzes their baseline characteristics and assesses the safety/toxicity of ICBT in this high-risk population.A retrospective analysis of patients treated with ICBT between September 2012 and December 2014 was performed. Patients with ISR twice in a single location were eligible. Procedural complications included vessel dissection, perforation, tamponade, slow/absent blood flow, and vessel closure. Postprocedural events included myocardial infarction, coronary artery bypass graft, congestive heart failure, stroke, bleeding, thrombosis, embolism, dissection, dialysis, or death occurring within 72 hours. A control group of patients with 2 episodes of ISR at 1 location who underwent percutaneous coronary intervention without ICBT was identified. Unpaired t tests and χ2 tests were used to compare the groups.There were 134 (78%) patients in the ICBT group with 141 treated lesions and 37 (22%) patients in the control group. There was a high prevalence of hyperlipidemia (>95%), hypertension (>95%), and diabetes (>50%) in both groups. The groups were well-balanced with respect to age, sex, and pre-existing medical conditions, with the exception of previous coronary artery bypass graft being more common the ICBT group. Procedural complication rates were low in the control and ICBT groups (0% vs 4.5%, P = .190). Postprocedural event rates were low (<5%) in both groups. Readmission rate at 30 days was 3.7% in the ICBT group and 5.4% in the control group (P = .649).This is the largest recent known series looking at ICBT for recurrent ISR of DES. ICBT is a safe treatment option with similarly low rates (<5%) of procedural and postprocedural complications compared with percutaneous coronary intervention alone. This study establishes the safety of ICBT in a high-risk patient cohort.

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Optical coherence tomography images of bell-shaped appearance in late sirolimus-eluting stent restenosis with extension of previous incomplete stent apposition.

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