Korean Circ J.  2011 Jul;41(7):409-412. 10.4070/kcj.2011.41.7.409.

Late Stent Thrombosis After Drug-Eluting Stent Implantation: A Rare Case of Accelerated Neo-Atherosclerosis and Early Manifestation of Neointimal Rupture

• Yang YJ
• Kim M
• Kim C
• Park J
• Oh J
• Won H
• Kim BK
• Hong MK

• KMID: 2225107
• DOI: http://doi.org/10.4070/kcj.2011.41.7.409

Abstract

An 80-year old woman suffered from sudden onset of chest pain and dyspnea, and visited the emergency room. She received stent implantation with a biolimus A9-eluting stent (Nobori(R) 3.0x24 mm) at a the mid-portion of the left anterior descending artery 5 months prior to admission. The emergency 5-month follow-up angiogram was performed under the impression of late stent thrombosis. The follow-up angiogram showed subtotal occlusion at the mid-portion of the left anterior descending artery, which was the same segment of previous stent implantation 5 months ago. Immediately after thrombus aspiration with the thrombus aspiration catheter, the optical coherence tomography showed layered appearance of neointimal hyperplasia and neointimal rupture within the previously stented segment. Thus, neointimal rupture within accelerated growth of neointimal tissue was observed within a relatively shorter period (i.e., about 5 months) after stent implantation.

Keyword

Stents; Thrombosis; Neointima

MeSH Terms

Arteries
Catheters
Chest Pain
Drug-Eluting Stents
Dyspnea
Emergencies
Female
Follow-Up Studies
Humans
Hyperplasia
Neointima
Rupture
Stents
Thrombosis
Tomography, Optical Coherence

Figure

• 

  Fig. 1 First electrocardiogram at recorded in the emergency room; the Q wave was visible at on leads V1-4.

• 

  Fig. 2 Pre-intervention (A) and post-intervention (B) angiographic findings in lesion of the left anterior descending artery (arrow in A) are sh-own 5-months before the onset of late stent thrombosis. At the onset of late stent thrombosis, emergency follow-up angiogram showed subtotal occlusion at the mid-portion of the left anterior descending artery (C). The final angiogram, performed after balloon angioplasty with a drug eluting balloon, showed no residual stenosis at the mid-portion of the left anterior descending artery and a jailed diagonal branch (D).

• 

  Fig. 3 The optical coherence tomography (OCT) showed layered appearance (arrowhead) of neointmal hyperplasia and neointimal rupture (arrow) within the previously stented segment (A and B). OCT image after balloon angioplasty with a drug eluting balloon (C).

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