A Case of In-Stent Plaque Rupture Presenting as an Acute Myocardial Infarction

Baek, Eun Kyung; Park, Seong Hoon; Kwon, Ki Hwan; Shim, Eun Jin; Jo, Jung Youn

doi:10.4070/kcj.2008.38.8.432

Cited by 3 publications

(1 citation statement)

References 13 publications

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“…Several authors recently reported a substantial number of bare-metal stent (BMS)-related restenosis cases presenting as acute coronary syndromes (ACS) 1) 2) and several case reports providing intravascular ultrasound (IVUS) evidence of pla-que rupture at in-stent neointima. 3) 4) Although IVUS is widely used to evaluate plaque composition, it has inherent image qu-ality limitations when compared with optical coherence tomography (OCT) for the assessment of soft tissue components and subtle surface changes in atherosclerotic lesions. 5) 6) Here, we present a patient with ACS in whom a combination of IVUS and OCT imaging showed atheromatous changes and plaque rupture of neointima 10 years after BMS implantation.…”

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confidence: 99%

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

et al. 2011

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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In‐stent restenotic lesions can rupture—A case against plaque sealing

Hoole

Starovoytov

Hamburger

2010

Cathet Cardio Intervent

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We present a case of plaque rupture located inside a restenotic stent. Intravascular ultrasound defined a lesion with a minimal lumen area (MLA) of 3.59 cm², plaque burden of 72%, and reference vessel luminal diameter of 4.0 mm with an external elastic membrane lumen cross-section area of 12.6 mm². There was a clearly identified plaque rupture, with a flap-like dissection within the stented segment. Virtual histology intravascular ultrasound confirmed that the adjacent plaque had necrotic core with a thin overlying fibrous cap. The remaining tissue next to the dissection plane was fibrotic. This case illustrates that neointimal hyperplasia may organize into an unstable plaque, with a thin fibrous cap overlying a lipid-rich necrotic core-a so-called virtual histology thin-capped fibroatheroma. As defined in the PROSPECT trial, the in-stent stenotic lesion in our case conformed to the definition of a high-risk plaque-it had an MLA < 4 mm², plaque burden was ≥ 70%, and there was >10% necrotic core. It became unstable and ruptured. The demonstrated findings of this case may sway physicians against sealing hemodynamically nonsignificant unstable plaques.

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A severely calcified neointima 9 years after bare metal stent implantation

Yoshida

Sadamatsu

2012

Cardiovascular Revascularization Medicine

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A Case of In-Stent Plaque Rupture Presenting as an Acute Myocardial Infarction

Cited by 3 publications

References 13 publications

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

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

In‐stent restenotic lesions can rupture—A case against plaque sealing

A severely calcified neointima 9 years after bare metal stent implantation

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