- Email: [email protected]
Delayed Healing of a Coronary Stent Graft
JACC: CARDIOVASCULAR INTERVENTIONS
VOL. 4, NO. 4, 2011
© 2011 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 1936-8798/$36.00
PUBLISHED BY ELSEVIER INC.
DOI: 10.1016/j.jcin.2010.09.028
IMAGES IN INTERVENTION
Delayed Healing of a Coronary Stent Graft Masamichi Takano, MD,* Masanori Yamamoto, MD,* Toru Inami, MD,* Daisuke Murakami, MD,* Yoshihiko Seino, MD,* Kyoichi Mizuno, MD† Chiba and Tokyo, Japan
A polytetrafluoroethylene (PTFE)-covered stent composed of 2 metallic stents and sandwiched PTFE membrane is specially used for bailout of percutaneous intervention complicated with coronary perforation and treatment of aneurysms to prevent subsequent rupture. Detailed features within coronary stent grafts have not yet been reported in living
patients. A 65-year-old man underwent PTFEcovered stent (3.5/19 mm) deployment to seal a giant aneurysm in the right coronary artery. Follow-up angiography at 32 months showed patency and slightly irregular contour of the stent segment. Coronary angioscopy showed sufficient neointimal growth at the stent proximal edge.
Figure 1. Coronary Angiographic and Angioscopic Findings (A) Angiography shows a giant aneurysm in the distal right coronary artery (white arrow). (B) The aneurysm disappears immediately after stent graft implantation (white arrow). (C) Angiograms 32 months later show minimum wall irregularity within the stent graft (upper panel). Angioscopic images (lower panels) exhibit bright struts of the mid portion without any surrounding tissues (white arrow) and red mural thrombi in the distal portion (white arrow). A white membranous tissue covers over struts at the proximal edge (white arrowhead). Asterisks indicate guidewires (Online Video 1).
From the *Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan; and the †Division of Cardiology, Nippon Medical School, Tokyo, Japan. The authors have reported that they have no relationships to disclose. Manuscript received July 22, 2010; revised manuscript received September 10, 2010, accepted September 17, 2010.
Takano et al. Delayed Healing of a Coronary Stent Graft
JACC: CARDIOVASCULAR INTERVENTIONS, VOL. 4, NO. 4, 2011 APRIL 2011:466 –7
467
Figure 2. OCT Findings Optical coherence tomography (OCT) demonstrates relatively thick neointima at the proximal edge (white arrowheads in A), uncovered struts in the mid portion (white arrows in B), and protruding thrombi in the distal portion (red arrows in C).
Several struts in the mid portion were regarded as exposed struts lacking neointimal coverage. Red thrombi were found in the distal portion despite continuous oral anticoagulation and dual antiplatelet therapies (Fig. 1, Online Video 1). Optical coherence tomography confirmed the presence of uncovered struts as well as thrombus formation (Fig. 2). Pathological validation using light and electron microscopy has demonstrated incomplete endothelialization and accumulation of fibrin clots within endovascular stent grafts deployed for aortic aneurysms (1). The current intracoronary images suggest that delayed healing and thrombogenicity of coronary stent graft persists for an extended period.
Reprint requests and correspondence: Dr. Masamichi Takano, Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamakari, Inzai, Chiba 270 –1694, Japan. Email: [email protected].
REFERENCE
1. McArthur C, Teodorescu V, Eisen L, et al. Histopathologic analysis of endovascular stent grafts from patients with aortic aneurysms: does healing occur? J Vasc Surg 2001;33:733– 8.
APPENDIX For an accompanying video, please see the online version of this article.
VOL. 4, NO. 4, 2011
© 2011 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 1936-8798/$36.00
PUBLISHED BY ELSEVIER INC.
DOI: 10.1016/j.jcin.2010.09.028
IMAGES IN INTERVENTION
Delayed Healing of a Coronary Stent Graft Masamichi Takano, MD,* Masanori Yamamoto, MD,* Toru Inami, MD,* Daisuke Murakami, MD,* Yoshihiko Seino, MD,* Kyoichi Mizuno, MD† Chiba and Tokyo, Japan
A polytetrafluoroethylene (PTFE)-covered stent composed of 2 metallic stents and sandwiched PTFE membrane is specially used for bailout of percutaneous intervention complicated with coronary perforation and treatment of aneurysms to prevent subsequent rupture. Detailed features within coronary stent grafts have not yet been reported in living
patients. A 65-year-old man underwent PTFEcovered stent (3.5/19 mm) deployment to seal a giant aneurysm in the right coronary artery. Follow-up angiography at 32 months showed patency and slightly irregular contour of the stent segment. Coronary angioscopy showed sufficient neointimal growth at the stent proximal edge.
Figure 1. Coronary Angiographic and Angioscopic Findings (A) Angiography shows a giant aneurysm in the distal right coronary artery (white arrow). (B) The aneurysm disappears immediately after stent graft implantation (white arrow). (C) Angiograms 32 months later show minimum wall irregularity within the stent graft (upper panel). Angioscopic images (lower panels) exhibit bright struts of the mid portion without any surrounding tissues (white arrow) and red mural thrombi in the distal portion (white arrow). A white membranous tissue covers over struts at the proximal edge (white arrowhead). Asterisks indicate guidewires (Online Video 1).
From the *Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan; and the †Division of Cardiology, Nippon Medical School, Tokyo, Japan. The authors have reported that they have no relationships to disclose. Manuscript received July 22, 2010; revised manuscript received September 10, 2010, accepted September 17, 2010.
Takano et al. Delayed Healing of a Coronary Stent Graft
JACC: CARDIOVASCULAR INTERVENTIONS, VOL. 4, NO. 4, 2011 APRIL 2011:466 –7
467
Figure 2. OCT Findings Optical coherence tomography (OCT) demonstrates relatively thick neointima at the proximal edge (white arrowheads in A), uncovered struts in the mid portion (white arrows in B), and protruding thrombi in the distal portion (red arrows in C).
Several struts in the mid portion were regarded as exposed struts lacking neointimal coverage. Red thrombi were found in the distal portion despite continuous oral anticoagulation and dual antiplatelet therapies (Fig. 1, Online Video 1). Optical coherence tomography confirmed the presence of uncovered struts as well as thrombus formation (Fig. 2). Pathological validation using light and electron microscopy has demonstrated incomplete endothelialization and accumulation of fibrin clots within endovascular stent grafts deployed for aortic aneurysms (1). The current intracoronary images suggest that delayed healing and thrombogenicity of coronary stent graft persists for an extended period.
Reprint requests and correspondence: Dr. Masamichi Takano, Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamakari, Inzai, Chiba 270 –1694, Japan. Email: [email protected].
REFERENCE
1. McArthur C, Teodorescu V, Eisen L, et al. Histopathologic analysis of endovascular stent grafts from patients with aortic aneurysms: does healing occur? J Vasc Surg 2001;33:733– 8.
APPENDIX For an accompanying video, please see the online version of this article.