title: Persistent malapposition after implantation of sirolimus-eluting stent into intramural coronary hematoma: optical coherence tomography observations.
abstract: A 76-year-old man presented with an anterior myocardial infarction. Coronary angiography showed 99% stenosis in the left anterior descending artery and total occlusion in the left circumflex artery (LCX). After successful percutaneus coronary intervention (PCI) for segment 7, a staged PCI to the LCX with a distal protection system was attempted, but the wire entered the subintima, creating a large dissection and intramural hematoma. Three sirolimus-eluting stents (SES) were implanted to cover the entire hematoma, but 2 weeks later intravascular ultrasound revealed stent malapposition, with healing of the residual hematoma, and vessel enlargement. Optical coherence tomography (OCT) showed the malapposition more clearly. Balloon dilatation successfully achieved apposition of the SES to the vessel wall, but 6 months later it revealed recurrence of malapposition, with the struts covered by thrombus-like tissue. This case suggests that SES implantation treatment of a long intramural hematoma can potentially cause late malapposition because of persistent vessel enlargement related to arterial wall injury and inhibition of neointimal hyperplasia by the SES. OCT is useful in showing the precise condition of the stent struts.
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular and Respiratory Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Sawada
authors.forename: Junya
authors.initials: J
authors.lastname: Shite
authors.forename: Toshiro
authors.initials: T
authors.lastname: Shinke
authors.forename: Satoshi
authors.initials: S
authors.lastname: Watanabe
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Otake
authors.forename: Daisuke
authors.initials: D
authors.lastname: Matsumoto
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Imuro
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ogasawara
authors.forename: Oscal Luis
authors.initials: OL
authors.lastname: Paredes
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yokoyama
mesh_terms: D000368:Aged; D002404:Catheterization; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology; D016503:Drug Delivery Systems / Q000379:methods*; D006406:Hematoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents / Q000009:adverse effects*; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome; D017539:Tunica Intima / Q000187:drug effects / Q000473:pathology; D014463:Ultrasonography
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus