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TCTAP C-234 Very Late Stent Thrombosis Caused by Obvious Very Late Acquired Stent Malapposition Assessed by Optical Coherence Tomography After Everolimus-eluting Stent Implantation into Sirolimus-eluting Stent
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Case Summary. We reported a young man without risk factors presenting with ischemic stroke. Serial radiological imaging studies were performed but could not confirm the diagnosis. By using intravascular ultrasound, carotid artery dissection was diagnosed. Carotid artery stenting was performed based upon the findings of intravascular ultrasound. TCTAP C-234 Very Late Stent Thrombosis Caused by Obvious Very Late Acquired Stent Malapposition Assessed by Optical Coherence Tomography After Everolimus-eluting Stent Implantation into Sirolimus-eluting Stent Yasunori Yamamoto,1 Yasushi Ino,1 Takashi Kubo,1 Yosuke Katayama,1 Hiroshi Aoki,1 Tsuyoshi Nishiguchi,1 Makoto Orii,1 Takeyoshi Kameyama,1 Takashi Yamano,1 Tomoyuki Yamaguchi,1 Yoshiki Matsuo,1 Hironori Kitabata,1 Atsushi Tanaka,1 Takeshi Hozumi,1 Takashi Akasaka1 1 Wakayama Medical University, Japan [CLINICAL INFORMATION] Patient initials or identifier number. I.M. Relevant clinical history and physical exam. A 70’s-year old man with hypertension and dyslipidemiaunderwent a sirolimus-eluting stent (SES) (3.0 * 18 mm) implantation in theproximal left anterior descending artery (LAD) 8 years ago. He had no in-stentrestenosis on 8-month follow-up coronary angiography (CAG).He was suffered fromST-elevation myocardial infarction (STEMI) due to very late stent thrombosis(VLST) of SES in the proximal LAD 7 years after SES implantation. Relevant test results prior to catheterization. His CAG revealed total occlusion within SES in theproximal LAD. He underwent an everolimuselutingstent (EES) (2.5 * 23 mm) implantation into SES after thrombus aspiration. He had no in-stent restenosis, no peri-stentcontrast staining (PSS), and only small stent malapposition on9-monthfollowup CAG and optical coherence tomography (OCT). He discontinuedtaking clopidogrel, and had continued only aspirin after that. Relevant catheterization findings. He was suffered from anterior STEMI 19 months after EES implantation and his emergent CAG revealed total occlusion within EES in the proximal LAD.
S387
S388
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
[INTERVENTIONAL MANAGEMENT] Procedural step. Thrombus aspiration (Thrombuster III, Kaneka) andballoon angioplasty using 3.25 15mmballoon were performed. Finally, TIMI 3 flow was obtained with intra-aorticballoon pumping (IABP) and this session was finished. Early follow-up CAG 2days after the procedure showed TIMI 3 flow and no residual stenosis orthrombus but peri-stent contrast staining (PSS) in the stenting lesion.Subsequently, OCT and intravascular ultrasound (IVUS) was performed. OCTrevealed several obvious uncovered struts, thrombus, and late stent malappositionsafter EES implantation. IVUS revealed expansive vessel remodeling at the siteof stent malapposition. No additional procedure was performed and IABP wasremoved that day. He had continued dual antiplatelet therapy with prasugrel plusaspirin after the admission. He had no chest pain and discharged 16 days afterthe procedure.
TCTAP C-235 Intravascular Ultrasound Guided Percutaneous Coronary Intervention in a Left Anterior Descending Artery Chronic Total Occlusion Debdatta Bhattacharyya,1 Ayan Kar,2 Debdatta Majumder2 1 Rabindranath Tagore International Institute of Cardiac Sciences, India; 2 NH-RTIICS, India [CLINICAL INFORMATION] Patient initials or identifier number. JP Relevant clinical history and physical exam. A 63 year old diabetic, hypertensive female patient presented with exertional angina. On examination pulse was 60 beats / min, all peripheral pulses were palpable with no anaemia, jaundice sign, edema or clubbing, with JVP. Blood pressure was 140 / 90 mmHg. Chest was clear & heart sound was normal with no murmur. Relevant test results prior to catheterization. ECG showed ST depression in V4 to V6, Echocardiogram shows good ejection fraction of 69% with normal valves and no chamber enlargement. Haemoglobin was 11.6 gm / dl. FPS was 116 mg /dl. HbA1C was 7. Blood urea 30 mg / dl, serum creatinine was 1.04mg/ dl. Total Cholesterol was 160 mg /dl, LDL cholesterol was 90 mg / dl and Triglyceride was 120 mg /dl. Relevant catheterization findings. LMCA: Normal LAD: Totally occluded in the proximal segment LCx: 30-40% stenosis in the distal segment RCA: Normal PDA: supplies extensive collaterals to LAD territory
Case Summary. In conclusion, VLST in this case was caused by obvious very late acquired stent malapposition with expansive vessel remodeling revealed by OCT and IVUS 19 months after everolimuseluting stent implantation into sirolimus-eluting stent.
Case Summary. We reported a young man without risk factors presenting with ischemic stroke. Serial radiological imaging studies were performed but could not confirm the diagnosis. By using intravascular ultrasound, carotid artery dissection was diagnosed. Carotid artery stenting was performed based upon the findings of intravascular ultrasound. TCTAP C-234 Very Late Stent Thrombosis Caused by Obvious Very Late Acquired Stent Malapposition Assessed by Optical Coherence Tomography After Everolimus-eluting Stent Implantation into Sirolimus-eluting Stent Yasunori Yamamoto,1 Yasushi Ino,1 Takashi Kubo,1 Yosuke Katayama,1 Hiroshi Aoki,1 Tsuyoshi Nishiguchi,1 Makoto Orii,1 Takeyoshi Kameyama,1 Takashi Yamano,1 Tomoyuki Yamaguchi,1 Yoshiki Matsuo,1 Hironori Kitabata,1 Atsushi Tanaka,1 Takeshi Hozumi,1 Takashi Akasaka1 1 Wakayama Medical University, Japan [CLINICAL INFORMATION] Patient initials or identifier number. I.M. Relevant clinical history and physical exam. A 70’s-year old man with hypertension and dyslipidemiaunderwent a sirolimus-eluting stent (SES) (3.0 * 18 mm) implantation in theproximal left anterior descending artery (LAD) 8 years ago. He had no in-stentrestenosis on 8-month follow-up coronary angiography (CAG).He was suffered fromST-elevation myocardial infarction (STEMI) due to very late stent thrombosis(VLST) of SES in the proximal LAD 7 years after SES implantation. Relevant test results prior to catheterization. His CAG revealed total occlusion within SES in theproximal LAD. He underwent an everolimuselutingstent (EES) (2.5 * 23 mm) implantation into SES after thrombus aspiration. He had no in-stent restenosis, no peri-stentcontrast staining (PSS), and only small stent malapposition on9-monthfollowup CAG and optical coherence tomography (OCT). He discontinuedtaking clopidogrel, and had continued only aspirin after that. Relevant catheterization findings. He was suffered from anterior STEMI 19 months after EES implantation and his emergent CAG revealed total occlusion within EES in the proximal LAD.
S387
S388
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
[INTERVENTIONAL MANAGEMENT] Procedural step. Thrombus aspiration (Thrombuster III, Kaneka) andballoon angioplasty using 3.25 15mmballoon were performed. Finally, TIMI 3 flow was obtained with intra-aorticballoon pumping (IABP) and this session was finished. Early follow-up CAG 2days after the procedure showed TIMI 3 flow and no residual stenosis orthrombus but peri-stent contrast staining (PSS) in the stenting lesion.Subsequently, OCT and intravascular ultrasound (IVUS) was performed. OCTrevealed several obvious uncovered struts, thrombus, and late stent malappositionsafter EES implantation. IVUS revealed expansive vessel remodeling at the siteof stent malapposition. No additional procedure was performed and IABP wasremoved that day. He had continued dual antiplatelet therapy with prasugrel plusaspirin after the admission. He had no chest pain and discharged 16 days afterthe procedure.
TCTAP C-235 Intravascular Ultrasound Guided Percutaneous Coronary Intervention in a Left Anterior Descending Artery Chronic Total Occlusion Debdatta Bhattacharyya,1 Ayan Kar,2 Debdatta Majumder2 1 Rabindranath Tagore International Institute of Cardiac Sciences, India; 2 NH-RTIICS, India [CLINICAL INFORMATION] Patient initials or identifier number. JP Relevant clinical history and physical exam. A 63 year old diabetic, hypertensive female patient presented with exertional angina. On examination pulse was 60 beats / min, all peripheral pulses were palpable with no anaemia, jaundice sign, edema or clubbing, with JVP. Blood pressure was 140 / 90 mmHg. Chest was clear & heart sound was normal with no murmur. Relevant test results prior to catheterization. ECG showed ST depression in V4 to V6, Echocardiogram shows good ejection fraction of 69% with normal valves and no chamber enlargement. Haemoglobin was 11.6 gm / dl. FPS was 116 mg /dl. HbA1C was 7. Blood urea 30 mg / dl, serum creatinine was 1.04mg/ dl. Total Cholesterol was 160 mg /dl, LDL cholesterol was 90 mg / dl and Triglyceride was 120 mg /dl. Relevant catheterization findings. LMCA: Normal LAD: Totally occluded in the proximal segment LCx: 30-40% stenosis in the distal segment RCA: Normal PDA: supplies extensive collaterals to LAD territory
Case Summary. In conclusion, VLST in this case was caused by obvious very late acquired stent malapposition with expansive vessel remodeling revealed by OCT and IVUS 19 months after everolimuseluting stent implantation into sirolimus-eluting stent.