title: Late stent malapposition with marked positive vascular remodeling observed only at the site of drug-eluting stents after multivessel coronary stenting.
abstract: A 74-year-old woman presented with effort-induced chest pain. Diagnostic coronary angiography revealed three-vessel disease. A successful angioplasty was performed with two sirolimus-eluting stents placed in the left anterior descending artery (LAD) and left circumflex artery (LCX). The right coronary artery (RCA) was treated with a bare-metal stent. Follow-up angiography and intravascular ultrasound (IVUS) assessment were performed 8 months later, which showed late stent malapposition (LSM) with marked positive vascular remodeling around the drug-eluting stents (DES) in both LAD and LCX lesions, but there was no evidence of ectatic area around the BMS in the RCA lesion. Compared with the baseline IVUS, a significant increase in external elastic membrane (EEM) cross-sectional area was found. Twenty-seven months later, we performed repeat follow-up angiography. Intravascular ultrasound still showed vessel malapposition. A previous report showed that aneurysmal dilatation of the stented segment with severe localized hypersensitivity reaction could be a potential cause of late thrombosis after DES implantation. If LSM is related to hypersensitivity of the DES, it may have a potential risk of adverse events. Although there is a paucity of data regarding malapposition as the cause of adverse events, careful long-term follow-up of patients with vessel enlargement after DES placement is recommended.
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahicho, Fuchu, Tokyo 183-0003, Japan. ywatana@shi.heart.or.jp
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Ryuta
authors.initials: R
authors.lastname: Asano
authors.forename: Noriko
authors.initials: N
authors.lastname: Hata
authors.forename: Kanki
authors.initials: K
authors.lastname: Inoue
authors.forename: Itaru
authors.initials: I
authors.lastname: Takamisawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Seki
authors.forename: Masaru
authors.initials: M
authors.lastname: Aikawa
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tobaru
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Misu
authors.forename: Nobuo
authors.initials: N
authors.lastname: Iguchi
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Nagayama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Watanabe
authors.forename: Morimasa
authors.initials: M
authors.lastname: Takayama
authors.forename: Jun
authors.initials: J
authors.lastname: Umemura
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sumiyoshi
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000008:administration & dosage; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology / Q000473:pathology; D008670:Metals; D011474:Prosthesis Design; D012720:Severity of Illness Index; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D002317:Cardiovascular Agents; D008670:Metals; D020123:Sirolimus