Department of Cardiology, Ehime Prefectural Imabari Hospital, 4-5-5 Ishii-chou, Imabari-shi, Ehime 790 0006, Japan.
J Cardiol. 2010 Jan;55(1):135-8. doi: 10.1016/j.jjcc.2009.04.006. Epub 2009 Jul 22.
Following the positioning of a bare metal stent (BMS) implant, a yellow plaque is healed with a reduction of the color grade and thrombogenicity, i.e. vulnerability by angioscopy in the chronic phase ("plaque sealing" of BMS; the "whitening effect" of BMS). However, we have reported that thrombus and yellow plaque increases at the drug-eluting stent (DES) site. A 71-year-old man underwent percutaneous coronary intervention using two DESs for a severe stenotic lesion in his right coronary artery. Follow-up coronary angiography (CAG) showed in-stent restenosis (ISR) at the stent-overlap site. We performed traditional balloon angioplasty, but follow-up CAG showed ISR again at the same position as the first restenosis. In angioscopic findings, the normal vessel wall was white, but the site of DES implantation was yellow and a yellow, soft, swelling neointimal proliferation-like vulnerable plaque was observed at the restenotic site. In expectation of the "whitening effect" of BMS, we implanted a new BMS. As anticipated, follow-up CAG showed no restenosis. Moreover, the angioscopic findings indicated a clean, white, neointimal proliferation-like stable plaque at the BMS implant site in the yellow vulnerable area of DES. The "BMS in DES" therapy should be considered one of the strategies for ISR of DES.
在裸金属支架（BMS）植入后，黄色斑块通过血管镜检查在慢性期显示颜色等级和血栓形成性降低，即易损性降低（BMS 的“斑块封闭”；BMS 的“白化效应”）。然而，我们已经报告了药物洗脱支架（DES）部位的血栓和黄色斑块增加。一名 71 岁男性因右冠状动脉严重狭窄病变而行经皮冠状动脉介入治疗，使用两个 DES。随访冠状动脉造影（CAG）显示支架重叠部位存在支架内再狭窄（ISR）。我们进行了传统的球囊血管成形术，但再次进行 CAG 检查显示在第一次再狭窄的同一部位出现 ISR。在血管镜检查结果中，正常血管壁为白色，但 DES 植入部位为黄色，在再狭窄部位观察到黄色、柔软、肿胀的新生内膜增生样易损斑块。考虑到 BMS 的“白化效应”，我们植入了新的 BMS。正如预期的那样，随访 CAG 显示没有再狭窄。此外，血管镜检查结果表明，在 DES 的黄色易损区域的 BMS 植入部位，存在干净、白色、新生内膜增生样稳定斑块。“DES 内 BMS”治疗应被视为 DES 的 ISR 的策略之一。
