Author + information
- Received August 31, 2012
- Accepted September 5, 2012
- Published online March 26, 2013.
A 55-year-old patient was admitted with a non–ST-segment elevation myocardial infarction. Eight years previously, he had received a bare-metal stent in the left circumflex coronary artery that maintained an excellent result on 6-month angiography. Angiography (A) disclosed focal in-stent restenosis together with a large thrombus (white arrow) within the stent (arrowheads). Optical coherence tomography revealed mild neointimal hyperplasia with a bright homogenous pattern at the distal stent segment (B, asterisk denotes wire artefact). Proximally, a large, protruding red thrombus (T) was clearly visualized, nicely separated from the adjacent uniform neointima (C). Neoatherosclerosis (D, E) was detected at the proximal edge of the stent (glistening neointima with attenuation) (plus signs) with a ruptured thin-cap fibroatheroma (D, yellow arrow). Notably, some distinct bright linear images (E, yellow double arrow) were identified, suggestive of macrophage accumulation. Malapposed or uncovered stent struts, however, were not detected. A large red thrombus was aspirated, and a drug-eluting stent was successfully implanted, with an excellent angiographic result.
Optical coherence tomography can be used to assess in-stent neoatherosclerosis. Ruptured neoatherosclerotic plaques with large intraluminal thrombi provide the “elusive missing link” between very late stent thrombosis and very late in-stent restenosis.
- Received August 31, 2012.
- Accepted September 5, 2012.
- American College of Cardiology Foundation