In-Stent Restenosis with "Inflammatory" Neointima Following Everolimus-Eluting Stent Implantation.

In-Stent Restenosis with "Inflammatory" Neointima Following Everolimus-Eluting Stent Implantation. Int Heart J. 2018 Jul 15;: Authors: Tsuji Y, Koide M, Katsura K, Fujita H, Ishibashi-Ueda H, Otsuka F Abstract A 53-year-old male presented with acute myocardial infarction and was subsequently implanted with a 4.0 × 28 mm everolimus-eluting platinum chromium stent in his proximal left anterior descending artery. Eight months after the implantation, he developed exertional angina and underwent coronary angiography, which revealed significant in-stent restenosis (ISR). Percutaneous coronary intervention was performed 1 month later, and the pre-procedural optical coherence tomography (OCT) revealed a diffusely bordered and rapidly attenuated signal-poor region with invisible stent struts at ISR site, potentially indicating a "lipid-laden" neointima. The ISR lesion was excised using a novel directional coronary atherectomy catheter. The histological analysis of the retrieved restenotic tissues revealed substantial inflammation characterized by abundant foamy macrophages and T-cell infiltration. This "inflammatory" neointimal tissue with numerous macrophages (without a necrotic core) detected on OCT was not expected owing to the absence of a known feature of macrophages on OCT (i.e., high backscattering with remarkable attenuation). The current histological confirmation of in vivo OCT findings of restenotic neointima indicated that a "lipi...
Source: International Heart Journal - Category: Cardiology Tags: Int Heart J Source Type: research