Araki Makoto, Hikita Hiroyuki, Sudo Yuta, Hishikari Keiichi, Takahashi Atsushi
Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan.
Int J Angiol. 2020 Mar;29(1):58-62. doi: 10.1055/s-0039-1685510. Epub 2019 Apr 16.
An expandable polytetrafluoroethylene (PTFE)-covered stent graft is beneficial for the treatment of coronary perforations. However, several reports have shown that restenosis and thrombotic occlusion occasionally occur in the stented segment after PTFE-covered stent implantation. A restenosis case after treatment with PTFE-covered stent against saphenous vein graft (SVG) perforation has never been evaluated with optical coherence tomography (OCT) or coronary angioscopy (CAS). This case report presents a 75-year-old man treated with a PTFE-covered stent after he suffered from SVG perforation 6 months ago. He was found to have a focal restenosis of the distal edge of the PTFE-covered stent and underwent percutaneous coronary intervention. OCT showed focal restenosis with homogeneous neointima and exposed struts in the middle and proximal part of the PTFE-covered stent. CAS showed white neointima with a smooth surface at the restenosis site and a sharp border against proximal exposed struts with characteristic links. This case study showed, for the first time in vivo and in a human, the neointimal characteristics of restenosis and uncovered stent struts in a PTFE-covered stent which had been implanted 6 months before. The delayed endothelialization was sustained until 12 months after implantation.
一种可扩张的聚四氟乙烯（PTFE）覆膜支架移植物对冠状动脉穿孔的治疗有益。然而，有几份报告显示，在植入PTFE覆膜支架后，支架段偶尔会发生再狭窄和血栓闭塞。PTFE覆膜支架治疗大隐静脉桥血管（SVG）穿孔后的再狭窄病例从未通过光学相干断层扫描（OCT）或冠状动脉血管镜检查（CAS）进行评估。本病例报告介绍了一名75岁男性，他在6个月前发生SVG穿孔后接受了PTFE覆膜支架治疗。发现他的PTFE覆膜支架远端边缘有局灶性再狭窄，并接受了经皮冠状动脉介入治疗。OCT显示PTFE覆膜支架中部和近端有局灶性再狭窄，伴有均匀的新生内膜和暴露的支柱。CAS显示再狭窄部位有白色光滑表面的新生内膜，与近端暴露的支柱有明显边界并伴有特征性连接。本病例研究首次在人体体内显示了植入6个月前的PTFE覆膜支架内再狭窄和未覆盖支架支柱的新生内膜特征。延迟内皮化持续到植入后12个月。
