title: Very late neoatherosclerotic plaque rupture in drug-eluting stent restenosis.
abstract: A 71-year-old man presented in emergency department for non-ST-elevation myocardial infarction. At admission, 12-lead ECG was in sinus rhythm without sign of myocardial ischemia, and troponin slightly increased. The only notable feature of the patient's medical history was single-vessel coronary artery disease revealed 10 years previously, treated by stenting of the second segment of the right coronary artery with a 3.0 x 25 mm bare metal stent. Three months later, intrastent restenosis was managed by implantation of a 3.0 × 28 mm paclitaxel-eluting stent. Two years before the present admission, following a non contributive stress test for atypical chest pain, coronary angiogram had found a 60% diffuse intrastent restenosis. The present coronary angiogram performed via a right transradial approach demonstrated a focal intrastent restenosis (85%) with irregular contours. Optical coherence tomography (OCT) showed an atherosclerotic intrastent neolesion with intimal tear. OCT demonstrated more precisely a minimal luminal area of 1.02 mm (77.9% area stenosis), two wide cavities (length 1.1 and 1.4 mm) separated by a plaque rupture of 6.8 mm. Myocardial ischemia was evenly demonstrated on this artery with a fractional flow reserve under 0.50 after 150 mg intracoronary adenosine bolus. The culprit lesion was treated by a 3.0 × 38 mm everolimus-eluting stent, with good angiographic results, confirmed on OCT.
authors.affiliation: Department of Interventional Cardiology, Hôpital Louis Pradel, Hospices Civils de Lyon and University Lyon1, Lyon, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Courand
authors.forename: Julie
authors.initials: J
authors.lastname: Dementhon
authors.forename: Gilles
authors.initials: G
authors.lastname: Rioufol
authors.forename: Gérard
authors.initials: G
authors.lastname: Finet
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D000068338:Everolimus; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D009204:Myocardial Revascularization / Q000379:methods*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D058226:Plaque, Atherosclerotic / Q000150:complications*; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D041623:Tomography, Optical Coherence
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus