Author + information
- Received February 9, 2012
- Accepted February 18, 2012
- Published online July 1, 2012.
- Antonios Karanasos, MD,
- Jurgen M.R. Ligthart, BSc and
- Evelyn Regar, MD, PhD⁎ ()
- ↵⁎Reprint requests and correspondence
: Dr. Evelyn Regar, Department of Cardiology, Thoraxcenter, BA-585, Erasmus University Medical Centre's Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
A 62-year-old man presented with inferior ST-segment elevation myocardial infarction for primary percutaneous coronary intervention. He had a history of myocardial infarction 15 years ago and had a bare-metal stent implanted in the right coronary artery. Upon presentation, coronary angiography revealed total occlusion of the right coronary artery, which was covered at its full length with stents (Fig. 1A). We performed thrombus aspiration with partial restoration of antegrade flow (Fig. 1B) and proceeded with optical coherence tomography imaging of the vessel.
Optical coherence tomography (Fig. 2,Online Video 1) revealed a highly heterogeneous tissue coverage, presenting with several features that resemble native atherosclerosis, such as calcific depositions and thin-cap fibroatheroma (1,2). A rupture was detected in the neointima with mural thrombus at the rupture site protruding into the lumen. The neointima had high variability across the stent demonstrating different patterns of coverage (3), as well as a peristrut low-intensity area, reported to correspond to areas of fibrin accumulation (4). Although, there have been pathological reports demonstrating growth of de novo atheromatic tissue inside stents (1), now with optical coherence tomography, it is feasible to unravel the complexity of this entity in vivo, as well as the mechanisms of thrombus formations in such cases.
Dr. Karanasos was supported by a grant from the Hellenic Heart Foundation. Dr. Ligthart is a consultant for Volcano Corp., Boston Scientific, and St. Jude Medical. Dr. Regar has reported that she has no relationships relevant to the contents of this paper to disclose.
- Received February 9, 2012.
- Accepted February 18, 2012.
- American College of Cardiology Foundation