Department of Cardiology, Ehime Prefectural Imabari Hospital, 4-5-5 Ishii-cho, Imabari, Ehime 794-0006, Japan.
J Cardiol. 2009 Aug;54(1):153-7. doi: 10.1016/j.jjcc.2008.10.010. Epub 2008 Dec 20.
Coronary angioscopy is a useful tool for understanding plaque characteristics through the plaque color and surface thrombus formation. We experienced an interesting case of a newly developed yellow neointima 400 days after a sirolimus-eluting stent implantation. A 72-year-old woman suffering from angina pectoris was admitted to our hospital. Coronary angiography revealed severe stenosis at the proximal left descending artery and she was implanted with a sirolimus-eluting stent. Coronary angioscopic observation immediately after stent implantation revealed the presence of yellow plaque only at the most severe stenosis lesion in the stent placement site. We performed a coronary angiography 400 days after the sirolimus-eluting stent implantation and did not find an in-stent restenosis. An intravascular ultrasound indicated minimum neointimal formation. By coronary angioscopy, we could clearly observe that the neointima had covered the surface of the stent struts; the stent struts were barely visible under the neointima. Surprisingly, neointima formed in response to the sirolimus-eluting stent was entirely yellow. Precise mechanisms of producing yellow neointima was unknown, we may observe a pathologic neointima induced by sirolimus-eluting stent.
冠状动脉血管内镜检查是一种通过斑块颜色和表面血栓形成来了解斑块特征的有用工具。我们遇到了一个有趣的病例，在雷帕霉素洗脱支架植入后 400 天出现了新形成的黄色新生内膜。一名 72 岁的女性因心绞痛入院。冠状动脉造影显示左前降支近端严重狭窄，植入了雷帕霉素洗脱支架。支架植入后即刻行冠状动脉血管内镜检查，仅在支架放置部位最严重狭窄病变处发现黄色斑块。我们在雷帕霉素洗脱支架植入后 400 天进行了冠状动脉造影，未发现支架内再狭窄。血管内超声显示最小的新生内膜形成。通过冠状动脉血管内镜检查，我们可以清楚地观察到新生内膜覆盖了支架梁的表面；在新生内膜下支架梁几乎看不见。令人惊讶的是，对雷帕霉素洗脱支架的反应形成的新生内膜完全是黄色的。对于黄色新生内膜形成的确切机制尚不清楚，我们可能观察到雷帕霉素洗脱支架引起的病理性新生内膜。
