Ataka Ryo, Saito Naritatsu, Tsujimura Akira, Kato Eri Toda, Kimura Takeshi
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Cardiovasc Revasc Med. 2019 Apr;20(4):365-367. doi: 10.1016/j.carrev.2018.10.011. Epub 2018 Dec 7.
An 80-year-old man with ST-segment elevation myocardial infraction underwent coronary stenting using an everolimus-eluting stent, which resulted in a good coronary flow with no residual stenosis. However, 10 min after final coronary angiography, the patient complained of chest discomfort and the ECG again showed ST elevation. Repeat coronary angiography revealed multiple contrast filling defects in the stent. High-definition 60-MHz intravascular ultrasound (IVUS) examination showed multiple low echoic structures inside the stent, though its visualization was not clear. We also conducted optical coherence tomography (OCT) for further investigation, which clearly delineated the outline of the thrombus. An additional balloon dilatation was performed at the site of the stented lesion, and the patient's chest discomfort was relieved, and the ECG was normalized. The clinical implication of this case is that very early phase of intra-stent thrombus is low-density and coarse, and its visualization is better in OCT than in high-definition 60 MHz IVUS.
一名80岁的ST段抬高型心肌梗死男性患者接受了依维莫司洗脱支架冠状动脉支架置入术，术后冠状动脉血流良好，无残余狭窄。然而，在最后一次冠状动脉造影后10分钟，患者主诉胸部不适，心电图再次显示ST段抬高。重复冠状动脉造影显示支架内有多个造影剂充盈缺损。高清60MHz血管内超声（IVUS）检查显示支架内有多个低回声结构，但其显示并不清晰。我们还进行了光学相干断层扫描（OCT）以进一步检查，其清晰地勾勒出了血栓的轮廓。在支架置入病变部位进行了额外的球囊扩张，患者的胸部不适得到缓解，心电图恢复正常。该病例的临床意义在于，支架内血栓的极早期为低密度且粗糙，其在OCT中的显示优于高清60MHz IVUS。
