Author + information
- Received December 9, 2014
- Accepted December 19, 2014
- Published online May 1, 2015.
- Fernando Rivero, MD,
- Javier Cuesta, MD,
- Amparo Benedicto, MD,
- Teresa Bastante, MD,
- Daniel Rodriguez-Alcudia, MD,
- M. Cruz Aguilera, MD and
- Fernando Alfonso, MD∗ ()
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP Universidad Autonoma de Madrid, Madrid, Spain
- ↵∗Reprint requests and correspondence:
Dr. Fernando Alfonso, Cardiac Department, Hospital Universitario de la Princesa, IIS-IP Universidad Autonoma de Madrid, C/Diego de Leon 62, 28006 Madrid, Spain.
A 72-old-year-man was admitted for an inferior ST-segment elevation acute myocardial infarction. Seven years earlier, a 2.75 × 15-mm bare-metal stent (BMS) was successfully implanted in the posterolateral branch of the right coronary artery (RCA) at another institution. Emergent coronary angiography showed a thrombotic occlusion at the mid-segment of the RCA (Figure 1). After multiple unsuccessful attempts to cross the occlusion, eventually a hydrophilic guidewire was advanced across the occluded segment. Thromboaspiration was unsuccessful despite the use of 2 different aspiration devices that were unable to cross the lesion. Optical coherence tomography (OCT) was performed to clarify the underlying substrate. A large intracoronary red thrombus with intense posterior shadowing that prevented an adequate visualization of the underlying vessel wall was revealed with OCT. At this point, the use of intravascular ultrasound (IVUS) was considered to further clarify the anatomy of this challenging lesion. IVUS revealed the presence of a metal structure embedded within the thrombus, highly suggestive of the presence of an “abandoned,” underexpanded intracoronary stent at this coronary segment. The “abandoned” stent was eventually crushed to the arterial wall with a new BMS. Subsequent hospitalization was uneventful.
Intracoronary loss of unexpanded stents is an infrequent but potentially serious complication that may occur unnoticed during the procedure (1,2). Despite its unique axial resolution, OCT may have major problems in identifying the culprit “phantom” underlying stent in the setting of a large thrombus burden. In this scenario, IVUS, despite its lower spatial resolution, readily visualizes structures behind thrombus content and fully delineates the complete vessel wall and the outer vessel contour, even without any coronary flow. Our findings demonstrate that IVUS may be especially useful for revealing the presence and disclose the characteristics of an underlying “phantom” stent, even in the presence of a large thrombus burden (3).
All authors have reported that they have no relationships with relevant to the contents of this paper to disclose.
- Received December 9, 2014.
- Accepted December 19, 2014.
- American College of Cardiology Foundation