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.

Keywords: Drug-eluting stent; In-stent restenosis; Incomplete stent apposition; Optical coherence tomography.

Figure 1

Serial angiography after the procedure and 1 and 3 years after sirolimus-eluting stent (white arrows) implantation in the left circumflex coronary artery. Peri-stent contrast staining (white arrowheads) was observed in the sirolimus-eluting stent 1 year after the procedure, and focal severe stenosis and expanding peri-stent contrast staining were observed at 3 years.

Figure 2

IVUS and OCT findings 3 years after the procedure. Both IVUS and OCT revealed large incomplete stent apposition (white arrowheads) and ulcer-like appearance around the stent struts (red arrowheads) at the right distal site of stenosis (A). At the stenotic site, only OCT clearly illustrated circumferential detachment of the intima from the stent (white arrow) at the stenotic site (B), and was not observed at the proximal site of stenosis (C). IVUS, intravascular ultrasound; OCT, optical coherence tomography; LCx, left circumflex artery; LMCA, left main coronary artery; SES, sirolimus-eluting stent. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)

Figure 3

3-Dimensional image can demonstrate the bell-shaped stenosis (white arrow), large incomplete apposition (white arrowheads) and stent strut of sirolimus-eluting stent (red arrowheads) in the optical coherence tomography image. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)