Masuda Shinichiro, Shibui Takashi, Kawamura Ryuki, Saiki Hitoshi, Hata Akihiro
Department of Cardiology, Tokyo Metropolitan Hiroo Hospital.
Department of Cardiology, Tokyo Metropolitan Health and Medical Corporation Toshima Hospital.
Int Heart J. 2018 Jan 27;59(1):209-212. doi: 10.1536/ihj.16-598. Epub 2017 Dec 27.
A 43-year-old man was admitted to our hospital with ST-segment elevation acute coronary syndrome. He had experienced myocardial infarction 19 months previously, and a bare-metal stent (BMS) had been implanted in the culprit distal right coronary artery at another hospital. Emergency coronary angiography showed thrombotic in-stent occlusion of the BMS. Intravascular ultrasound revealed an undersized stent compared with the size of the vessel and late stent malapposition (LSM) with abundant thrombi. The lesion was successfully recanalized via thrombectomy and plain old balloon angioplasty. Optical frequency domain imaging performed at follow-up coronary angiography confirmed the improvement of the LSM and incomplete neointimal stent coverage. This report illustrates the importance of imaging modalities in elucidating the mechanism of BMS-related very late stent thrombosis.
一名43岁男性因ST段抬高型急性冠状动脉综合征入住我院。他在19个月前曾发生过心肌梗死，另一家医院在罪犯血管右冠状动脉远端植入了一枚裸金属支架（BMS）。急诊冠状动脉造影显示BMS内血栓形成导致支架闭塞。血管内超声显示支架尺寸小于血管尺寸，存在晚期支架贴壁不良（LSM）且有大量血栓。通过血栓切除术和普通球囊血管成形术成功使病变血管再通。随访冠状动脉造影时进行的光学频域成像证实LSM有所改善，且新生内膜对支架的覆盖不完全。本报告说明了成像方式在阐明BMS相关极晚期支架血栓形成机制中的重要性。
