Ito Shigenori, Saeki Tomoaki
Division of Cardiology, Nagoya City East Medical Center, Nagoya, Japan.
J Cardiol Cases. 2015 Aug 11;12(5):145-149. doi: 10.1016/j.jccase.2015.06.004. eCollection 2015 Nov.
A 69-year-old man underwent repeat percutaneous coronary intervention for in-stent restenosis in the obtuse marginal artery 8 months after biolimus-eluting stent (2.5 × 28 mm Nobori stent, Terumo, Tokyo, Japan) implantation. Coronary angiography showed focal stenosis in the distal part of the stent. Intravascular ultrasound revealed low echoic heterogeneous intimal tissue. Optical coherence tomography also revealed a heterogeneous finding classified as a layered pattern. Coronary angioscopy detected a white mass with a paste-like appearance at the stenosis extending around the in-stent restenosis as a thin membrane where stent strut could be seen transparently. A small part of the mass was swinging in the blood stream. Coronary angioscopic imaging was beneficial for the understanding of the suspected mechanism and feature of the in-stent restenosis after second-generation stent implantation, which was apparently different from neointimal hyperplasia after bare-metal stent implantation. < The learning objectives of this case report include understanding the mechanism of in-stent restenosis after second-generation drug-eluting stent implantation by showing the coronary angioscopic imaging beyond the other intravascular imaging. In particular, this case can make the general and interventional cardiologists learn that the mechanism of in-stent restenosis <1 year is different from that after bare-metal stent implantation.>.
一名69岁男性在植入生物可吸收涂层洗脱支架（2.5×28mm Nobori支架，日本东京泰尔茂公司）8个月后，因钝缘支动脉支架内再狭窄接受了再次经皮冠状动脉介入治疗。冠状动脉造影显示支架远端存在局灶性狭窄。血管内超声显示内膜组织呈低回声且不均匀。光学相干断层扫描也显示出一种分类为分层模式的不均匀表现。冠状动脉血管镜检查发现在狭窄处有一个外观呈糊状的白色团块，围绕支架内再狭窄呈薄膜状延伸，在此可清晰看到支架小梁。团块的一小部分在血流中摆动。冠状动脉血管镜成像有助于理解第二代支架植入后支架内再狭窄的可疑机制和特征，这明显不同于裸金属支架植入后的新生内膜增生。<本病例报告的学习目标包括通过展示超越其他血管内成像的冠状动脉血管镜成像，来理解第二代药物洗脱支架植入后支架内再狭窄的机制。特别是，本病例可使普通心脏病专家和介入心脏病专家了解到，1年内支架内再狭窄的机制与裸金属支架植入后的机制不同。>
