Kashiwagi Manabu, Tanimoto Takashi, Kitabata Hironori
Department of Cardiology, Shingu Municipal Medical Center, Shingu, Japan.
Case Rep Cardiol. 2018 May 29;2018:5764897. doi: 10.1155/2018/5764897. eCollection 2018.
A 74-year old man presented recurrent angina pectoris due to in-stent restenosis (ISR) with severely calcified neointima. In-stent neoatherosclerosis (NA) is associated with late stent failure, and NA with calcified neointima occurs in some cases. Because the presence of neointimal calcification could lead to underexpansion of newly implanted stent for ISR, a scoring balloon was selected for predilatation to obtain maximum extrusion of the neointimal plaque and subsequently, an everolimus-eluting stent was implanted. However, moderate stenosis remained on coronary angiography, and optical coherence tomography (OCT) revealed underexpansion of the newly implanted stent because an attempt at balloon dilatation of neointimal calcification failed. Although OCT can clearly discriminate stent struts from neointimal calcification, we did not perform OCT assessment between scoring balloon and stenting. It is highly recommended to confirm whether the lesion is adequately treated by balloon angioplasty before stenting in cases with calcified ISR.
一名74岁男性因支架内再狭窄（ISR）合并严重钙化的新生内膜而出现复发性心绞痛。支架内新动脉粥样硬化（NA）与晚期支架失败有关，且部分病例会出现伴有钙化新生内膜的NA。由于新生内膜钙化的存在可能导致用于ISR的新植入支架扩张不足，因此选择了刻痕球囊进行预扩张，以最大程度地挤压新生内膜斑块，随后植入了依维莫司洗脱支架。然而，冠状动脉造影显示仍有中度狭窄，光学相干断层扫描（OCT）显示新植入的支架扩张不足，原因是对新生内膜钙化进行球囊扩张的尝试失败。尽管OCT能够清晰地区分支架小梁与新生内膜钙化，但我们在刻痕球囊扩张和支架植入之间未进行OCT评估。强烈建议在钙化性ISR病例中，在支架植入前确认病变是否通过球囊血管成形术得到充分治疗。
