title: A case of extended late-phase in-stent restenosis after implantation of a bare-metal stent: intravascular ultrasound, optical coherence tomography and immunohistochemical findings.
abstract: Although extended late-phase in-stent restenosis has been reported even after implantation of bare-metal stents (BMS), the data resolving the mechanism are sparse. We could obtain intravascular ultrasound, optical coherence tomography (OCT), and immunohistochemical findings by retrieving the material that prolapsed distal to the stent after balloon angioplasty for the in-stent restenosis 12 years after BMS implantation in a 76-year-old man. OCT showed homogeneous high signal in the distal segment and high signal accompanied by attenuation in the proximal segment. Low signals around the stent struts and tubular structure in the deep layer were also detected, suggesting the existence of inflammation and neovascularization, respectively. Fibrous collagenous plaque was adjacent to the lesion where polymorphic smooth muscle cells (immunoreactivity to smooth muscle cell α-actin) proliferates with rich proteoglycan at the background with invasion of macrophages (immunoreactivity to CD 68) as a border. These findings may indicate the multiple healing process after plaque rupture or erosion even in the stented coronary segment.
authors.affiliation: Division of Cardiology, East Medical Center, Higashi Municipal Hospital City of Nagoya, 1-2-23, Wakamizu-cho, Chikusa-ku, Nagoya-shi, Aichi-ken, 464-8547, Japan. sito@higashi-hosp.jp
authors.forename: Shigenori
authors.initials: S
authors.lastname: Ito
authors.forename: Takayuki
authors.initials: T
authors.lastname: Yoshida
authors.forename: Shugo
authors.initials: S
authors.lastname: Suzuki
mesh_terms: D000199:Actins / Q000378:metabolism; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D023903:Coronary Restenosis / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D008264:Macrophages / Q000378:metabolism / Q000473:pathology; D008297:Male; D009131:Muscle, Smooth, Vascular / Q000378:metabolism / Q000473:pathology; D015607:Stents; D041623:Tomography, Optical Coherence; D018084:Ultrasonography, Interventional; D000097382:CD68 Molecule
chemical_list: D000199:Actins; D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; C067980:CD68 antigen, human; D000097382:CD68 Molecule