Multi-modality visualization with three-dimensional reconstruction of neointimal plaque rupture after bare metal stent implantation.
Multi-modality visualization with three-dimensional reconstruction of neointimal plaque rupture after bare metal stent implantation.
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裸金属支架植入后新内膜斑块破裂的多模态可视化三维重建。
DOI：
10.1016/j.jcin.2014.04.023
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Atsushi Hirayama
中科院分区：
文献类型：
--
作者：
Mitsumasa Sudo;Takafumi Hiro;Tadateru Takayama;Korehito Iida;Naotaka Akutsu;Toshihiko Nishida;Takashi Kanai;Taro Kawano;Yoshiharu Higuchi;Atsushi Hirayama
裸金属支架植入后，极晚期支架血栓形成(VLST)被认为是罕见的。VLST最常见的原因是新生内膜斑块破裂(1)。以前的一些使用单一成像设备的报告显示，它是基于新生内膜的动脉粥样瘤性变化[2]。然而，支架内新生内膜破裂的原因尚不完全清楚。在此例中(图1、2和3)，对裸露金属支架内的新生内膜破裂进行了多模式成像，包括冠状动脉造影、血管内超声、冠状动脉内窥镜、光学相干断层扫描(OCT)和穿透式或半切式三维OCT。支架内新生内膜破裂处充满黄色物质，破裂发生在新生内膜丘的近侧面朝近端。这些结果表明，新生内膜破裂部分有相当数量的脂质或类脂黄色成分，新内膜斑块丘近端的破裂可能与较高的切应力有关。推测VLST可以通过新生内膜局部剪应力的升高而发生。
After bare-metal stent implantation, very late stent thrombosis (VLST) is considered to be rare. The most frequent cause of VLST is neointimal plaque rupture (1). Some previous reports with using a single imaging device have revealed that it is based on atheromatous changes of the neointima (2). However, it has not been fully clarified why an in-stent neointima could rupture. In this case (Figures 1, 2, and 3), multimodality imaging with coronary angiography, intravascular ultrasound, coronary angioscopy, optical coherence tomography (OCT), and walk-through or half-cut type3-dimensional OCT was performed for a neointimal rupture within a bare-metal stent. The ruptured site of the in-stent neointima was filled with yellow material, and the rupture occurred at the proximal side of the neointima hill facing toward the proximal side. These findings suggested that the ruptured portion of the neointima had a fair amount of lipid or lipidlike yellow content and that the rupture at the proximal side of the neointimal plaque hill might be related to higher shear stress (3). It was speculated that VLST can occur through a neointima rupture by the local elevation of shear stress of the neointima.