A Case of In-Stent Neointimal Plaque Rupture 10 Years After Bare Metal Stent Implantation: Intravascular Ultrasound and Optical Coherence Tomographic Findings

Abstract

Neointimal hyperplasia mainly develops within several months of coronary stent deployment, after which it stabilizes. Although it was widely accepted, particularly during the bare-metal stent (BMS) era, that in-stent restenosis (ISR) generally does not present as an acute coronary syndrome (ACS), but rather as a gradual recurrence of angina symptoms, recent data have shown that a substantial number of patients with ISR present as ACS. There has also been consistent postmortem evidence of plaque rupture secondary to atherosclerotic change within the neointima of a BMS. We report here a case of ACS in which intravascular ultrasound and optical coherent tomographic assessments revealed neointimal atherosclerotic change and ruptured plaque 10 years after BMS deployment.

A Case of In-Stent Neoatherosclerosis 10 Years after Carotid Artery Stent Implantation: Observation with Optical Coherence Tomography and Plaque Histological Findings

“… 5 – 9 , 15) The main causes of VLST are thought to be neointimal atherosclerotic changes inside the stent and plaque ruptures of the neointima. 16 , 17) These findings of neointimal response, called “neoatherosclerosis,” have been assessed in coronary interventions by various imaging techniques and by the pathological features. Nakazawa et al reported that atherosclerotic change of the neointima was observed significantly earlier and more frequently in cases where DES were used compared to BMS.…”

“…Most recently, several OCT studies demonstrated that neointima within BMS or DES may transform into unstable atherosclerotic plaque. 5 , 15 , 17 , 20 , 21) OCT has been used for human coronary imaging. 22 , 23) OCT has a 10-fold higher image resolution than conventional IVUS and is able to provide superior intraluminal image quality.…”