Severely Circumferentially Calcified Neointima as a New Cause of Undilatable In-Stent Restenosis

Case Reports in Cardiology
Manabu KashiwagiHironori Kitabata

Abstract

A 74-year old man presented recurrent angina pectoris due to in-stent restenosis (ISR) with severely calcified neointima. In-stent neoatherosclerosis (NA) is associated with late stent failure, and NA with calcified neointima occurs in some cases. Because the presence of neointimal calcification could lead to underexpansion of newly implanted stent for ISR, a scoring balloon was selected for predilatation to obtain maximum extrusion of the neointimal plaque and subsequently, an everolimus-eluting stent was implanted. However, moderate stenosis remained on coronary angiography, and optical coherence tomography (OCT) revealed underexpansion of the newly implanted stent because an attempt at balloon dilatation of neointimal calcification failed. Although OCT can clearly discriminate stent struts from neointimal calcification, we did not perform OCT assessment between scoring balloon and stenting. It is highly recommended to confirm whether the lesion is adequately treated by balloon angioplasty before stenting in cases with calcified ISR.

References

Mar 23, 2004·Cardiovascular Pathology : the Official Journal of the Society for Cardiovascular Pathology·Katsumi InoueTadaomi Alfonso Miyamoto
Mar 8, 2011·Journal of the American College of Cardiology·Gaku NakazawaRenu Virmani
Feb 18, 2012·Circulation. Cardiovascular Interventions·Fernando AlfonsoChristian Nolte
Aug 18, 2012·Cardiovascular Revascularization Medicine : Including Molecular Interventions·Keiki Yoshida, Kenji Sadamatsu
Jul 4, 2015·Journal of the American College of Cardiology·Fernando AlfonsoUNKNOWN RIBS IV Study Investigators (under auspices of Interventional Cardiology Working Group of Spanish Society of Cardiology)
Jun 16, 2016·Arquivos brasileiros de cardiologia·Emile MehannaHiram Grando Bezerra

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