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Case Reports
. 2020 Mar;29(1):58-62.
doi: 10.1055/s-0039-1685510. Epub 2019 Apr 16.

Restenosis of a Polytetrafluoroethylene-Covered Stent Visualized by Coronary Angioscopy and Optical Coherence Tomography: A Case Report

Makoto Araki  1 , Hiroyuki Hikita  1 , Yuta Sudo  1 , Keiichi Hishikari  1 , Atsushi Takahashi  1
Affiliations
Case Reports

Restenosis of a Polytetrafluoroethylene-Covered Stent Visualized by Coronary Angioscopy and Optical Coherence Tomography: A Case Report

Makoto Araki et al. Int J Angiol. 2020 Mar.

Abstract

An expandable polytetrafluoroethylene (PTFE)-covered stent graft is beneficial for the treatment of coronary perforations. However, several reports have shown that restenosis and thrombotic occlusion occasionally occur in the stented segment after PTFE-covered stent implantation. A restenosis case after treatment with PTFE-covered stent against saphenous vein graft (SVG) perforation has never been evaluated with optical coherence tomography (OCT) or coronary angioscopy (CAS). This case report presents a 75-year-old man treated with a PTFE-covered stent after he suffered from SVG perforation 6 months ago. He was found to have a focal restenosis of the distal edge of the PTFE-covered stent and underwent percutaneous coronary intervention. OCT showed focal restenosis with homogeneous neointima and exposed struts in the middle and proximal part of the PTFE-covered stent. CAS showed white neointima with a smooth surface at the restenosis site and a sharp border against proximal exposed struts with characteristic links. This case study showed, for the first time in vivo and in a human, the neointimal characteristics of restenosis and uncovered stent struts in a PTFE-covered stent which had been implanted 6 months before. The delayed endothelialization was sustained until 12 months after implantation.

Keywords: OCT; PCI; case study; coronary angioscopy; optical coherence tomography; percutaneous coronary intervention; polytetrafluoroethylene-covered stent.

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Conflict of interest statement

Conflict of Interest The authors declare that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Coronary angiogram shows tight stenosis in the proximal of the saphenous vein graft ( A ). A 3.5 × 18 mm everolimus-eluting stent (EES) is deployed ( B ). Coronary perforation after stent implantation ( C ). A 3.5 × 19 mm polytetrafluoroethylene-covered stent is implanted inside the EES to achieve hemostat ( D ).
Fig. 2
Fig. 2
Coronary angiogram shows a focal restenosis of the distal edge of the polytetrafluoroethylene (PTFE)-covered stent ( A ) and indicates corresponding optical coherence tomography (OCT) and coronary angioscopy (CAS) images ( B1 – B4 ). OCT and CAS images show no atherosclerotic change in distal saphenous vein graft ( B1a , B1b ). OCT images show extremely focal restenosis at the distal edge of the PTFE-covered stent with homogeneous neointima ( B2a ), exposed struts in the middle and proximal part of the PTFE-covered stent ( B3a ), and a thin layer of endothelialization in the most proximal everolimus-eluting stent (EES) part ( B4a ). CAS images show a focal white neointima with smooth surface at restenosis site ( B2b ), exposed struts with characteristic links in the middle and proximal part of PTFE-covered stent ( B3b ), and grade 1 endothelialization in the EES part ( B4b ).
Fig. 3
Fig. 3
In 6 months, coronary angiogram shows a focal restenosis of the distal edge of biodegradable polymer sirolimus-eluting stent (BP-SES) ( A ). Optical coherence tomography and coronary angioscopy images revealed stenosed BP-SES ( B1a , B1b ), uncovered proximal edge of BP-SES ( B2a , B2b ), and persistently uncovered polytetrafluoroethylene-covered stent ( B3 ).
See this image and copyright information in PMC

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