Heart and Vessels

, Volume 30, Issue 3, pp 406–409 | Cite as

Repeated occurrence of slow flow phenomenon during and late after sirolimus-eluting stent implantation

  • Kenji Sakata
  • Masanobu Namura
  • Toshimitsu Takagi
  • Naoto Tama
  • Isao Inoki
  • Hidenobu Terai
  • Yuki Horita
  • Masatoshi Ikeda
  • Masakazu Yamagishi
Case Report

Abstract

A 78-year-old man with unstable angina showed 90 % stenosis in the proximal left anterior descending artery. Pre-procedural intravascular ultrasound revealed ruptured plaque and attenuated plaque in the lesion. Under these conditions, two overlapping sirolimus-eluting stent (SES) implantation in this lesion resulted in slow flow which was recovered by intracoronary nitrates, nicorandil, and nitroprusside without further complications. When the patient showed up again 5 years later with recurrence of angina pectoris, angiography revealed a hazy ulcerated in-stent restenosis (ISR) at the site of the SES. Pre-procedural optical coherence tomography (OCT) imaging revealed multiple intimal ruptures, cavity formation behind the stent struts, a thin-cap fibroatheroma containing neointima surrounded by signal-poor, lipid-rich area in the proximal SES, suggesting the progression of neoatherosclerosis within SES. Importantly, there occurred slow flow again after balloon angioplasty for this lesion. We would suggest careful OCT examination is warranted to confirm development of neoatherosclerosis within the stent, and distal protection device should be considered to prevent slow flow phenomenon even in a patient with very late ISR.

Keywords

Optical coherence tomography Intravascular ultrasound Percutaneous coronary intervention (PCI) Slow flow phenomenon Neoatherosclerosis 

Supplementary material

380_2014_477_MOESM1_ESM.mpeg (1.5 mb)
Supplementary material 1 (MPEG 1548 kb) Movie 1. Pre-intervention optical coherence tomography movie shows fibrotic neointima with microvessels in the distal sirolimus-eluting stent, thin-cap fibroatheroma (TCFA), multiple intimal ruptures without thrombi, and TCFA containing neointima surrounded by signal-poor, lipid-rich area in the proximal sirolimus-eluting stent
380_2014_477_MOESM2_ESM.mpeg (1.5 mb)
Supplementary material 2 (MPEG 1548 kb) Movie 2. Post-intervention optical coherence tomography movie shows disappearance of the neoatherosclerosis

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Copyright information

© Springer Japan 2014

Authors and Affiliations

  • Kenji Sakata
    • 1
  • Masanobu Namura
    • 2
  • Toshimitsu Takagi
    • 2
  • Naoto Tama
    • 2
  • Isao Inoki
    • 2
  • Hidenobu Terai
    • 2
  • Yuki Horita
    • 2
  • Masatoshi Ikeda
    • 2
  • Masakazu Yamagishi
    • 1
  1. 1.Division of Cardiovascular MedicineKanazawa University Graduate School of MedicineKanazawaJapan
  2. 2.Division of CardiologyKanazawa Cardiovascular HospitalKanazawaJapan

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