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Drug-Coated Balloon Treatment of Very Late Stent Thrombosis Due to Complicated Neoatherosclerosis.

Alfonso F, Bastante T, Cuesta J, Benedicto A, Rivero F - Arq. Bras. Cardiol. (2016)

Bottom Line: We describe the treatment of a patient presenting with very-late stent thrombosis with the use of a drug-coated balloon.In this patient, optical coherence tomography disclosed that ruptured and complicated neoatherosclerosis was the underlying substrate responsible for the episode of very-late stent thrombosis.The potential use of drug-coated balloons in this unique scenario is discussed.

View Article: PubMed Central - PubMed

Affiliation: Hospital Universitario de La Princesa, Madrid, Spain.

ABSTRACT
We describe the treatment of a patient presenting with very-late stent thrombosis with the use of a drug-coated balloon. In this patient, optical coherence tomography disclosed that ruptured and complicated neoatherosclerosis was the underlying substrate responsible for the episode of very-late stent thrombosis. The potential use of drug-coated balloons in this unique scenario is discussed.

No MeSH data available.


Related in: MedlinePlus

A) Coronary angiography with a cranial angulation showing a tight lesion(resulting in a luminal filling defect) in the mid part of the stent(arrow), on the proximal left anterior descending coronary artery thathad a TIMI2 flow. B) Final result after DCB angioplasty.
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f1: A) Coronary angiography with a cranial angulation showing a tight lesion(resulting in a luminal filling defect) in the mid part of the stent(arrow), on the proximal left anterior descending coronary artery thathad a TIMI2 flow. B) Final result after DCB angioplasty.

Mentions: A 64-year-old man with hypercholesterolemia was admitted for a prolonged (3 hours)episode of chest pain at rest associated with nausea. Fourteen years before he hadrecieved a bare-metal stent for a severe lesion in the mid left anterior descendingcoronary artery. On admission, the ECG showed extensive T-wave inversion on theanterior leads. Urgent coronary angiography revealed a severe focal and eccentriclesion, with some haziness, at the mid segment of the stent, resulting in a TIMI 2coronary flow (Figure 1A). Optical coherencetomography (OCT) disclosed a well-expanded and apposed stent, nicely covered by athin ring of bright homogeneous neointima at the proximal and distal stent segments.However, neoatherosclerosis (glistening neointima overlying large lipid pools [ + ]shadowing the underlying stent struts) was readily recognized in the mid part of thestent (Figure 2A). In addition, a clearconfined rupture of the fibrous cap was also identified (yellow arrows, Figure 2B) close to an occlusive lipid plaqueassociated with a large red thrombus (Figure2C). Thromboaspiration was successful in improving the angiographic image andcoronary flow, but only obtained a limited amount of red thrombus. High-pressure (22bar) dilation with a noncompliant balloon yielded a good angiographic result. Then,a DCB (3 mm in diameter) was inflated for 60 seconds at this site, with an excellentfinal angiographic result and no images of residual dissections (Figure 1B). OCT confirmed a large lumen and thinresidual neointima along the entire stent segment, but disclosed some minorintra-stent dissections (white arrows, Figure2D, E, F) and some small residual laden thrombi at sites with residualneoatherosclerosis. The patient had an uneventful clinical outcome (peak troponin T427 ug/L) and was discharged two days later.


Drug-Coated Balloon Treatment of Very Late Stent Thrombosis Due to Complicated Neoatherosclerosis.

Alfonso F, Bastante T, Cuesta J, Benedicto A, Rivero F - Arq. Bras. Cardiol. (2016)

A) Coronary angiography with a cranial angulation showing a tight lesion(resulting in a luminal filling defect) in the mid part of the stent(arrow), on the proximal left anterior descending coronary artery thathad a TIMI2 flow. B) Final result after DCB angioplasty.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940154&req=5

f1: A) Coronary angiography with a cranial angulation showing a tight lesion(resulting in a luminal filling defect) in the mid part of the stent(arrow), on the proximal left anterior descending coronary artery thathad a TIMI2 flow. B) Final result after DCB angioplasty.
Mentions: A 64-year-old man with hypercholesterolemia was admitted for a prolonged (3 hours)episode of chest pain at rest associated with nausea. Fourteen years before he hadrecieved a bare-metal stent for a severe lesion in the mid left anterior descendingcoronary artery. On admission, the ECG showed extensive T-wave inversion on theanterior leads. Urgent coronary angiography revealed a severe focal and eccentriclesion, with some haziness, at the mid segment of the stent, resulting in a TIMI 2coronary flow (Figure 1A). Optical coherencetomography (OCT) disclosed a well-expanded and apposed stent, nicely covered by athin ring of bright homogeneous neointima at the proximal and distal stent segments.However, neoatherosclerosis (glistening neointima overlying large lipid pools [ + ]shadowing the underlying stent struts) was readily recognized in the mid part of thestent (Figure 2A). In addition, a clearconfined rupture of the fibrous cap was also identified (yellow arrows, Figure 2B) close to an occlusive lipid plaqueassociated with a large red thrombus (Figure2C). Thromboaspiration was successful in improving the angiographic image andcoronary flow, but only obtained a limited amount of red thrombus. High-pressure (22bar) dilation with a noncompliant balloon yielded a good angiographic result. Then,a DCB (3 mm in diameter) was inflated for 60 seconds at this site, with an excellentfinal angiographic result and no images of residual dissections (Figure 1B). OCT confirmed a large lumen and thinresidual neointima along the entire stent segment, but disclosed some minorintra-stent dissections (white arrows, Figure2D, E, F) and some small residual laden thrombi at sites with residualneoatherosclerosis. The patient had an uneventful clinical outcome (peak troponin T427 ug/L) and was discharged two days later.

Bottom Line: We describe the treatment of a patient presenting with very-late stent thrombosis with the use of a drug-coated balloon.In this patient, optical coherence tomography disclosed that ruptured and complicated neoatherosclerosis was the underlying substrate responsible for the episode of very-late stent thrombosis.The potential use of drug-coated balloons in this unique scenario is discussed.

View Article: PubMed Central - PubMed

Affiliation: Hospital Universitario de La Princesa, Madrid, Spain.

ABSTRACT
We describe the treatment of a patient presenting with very-late stent thrombosis with the use of a drug-coated balloon. In this patient, optical coherence tomography disclosed that ruptured and complicated neoatherosclerosis was the underlying substrate responsible for the episode of very-late stent thrombosis. The potential use of drug-coated balloons in this unique scenario is discussed.

No MeSH data available.


Related in: MedlinePlus