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(Circulation. 2005;112:e345-e346.)
© 2005 American Heart Association, Inc.

Images in Cardiovascular Medicine

Optical Coherence Tomography Findings at 5-Year Follow-Up After Coronary Stent Implantation

E. Regar, MD, PhD; H.M.M. van Beusekom, PhD; W.J. van der Giessen, MD, PhD; P.W. Serruys, MD, PhD

From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.

Correspondence to Dr E. Regar, Thoraxcentre, Bd 408, Dr Molewaterplein 40, NL-3015 GD Rotterdam, The Netherlands. E-mail e.regar{at}erasmusmc.nl

Optical coherence tomography (OCT) is an in vivo, high-resolution imaging modality (resolution, 12 µm; wavelength, 1300 nm; probe size, 0.018 inch; Lightlab Imaging). The principle is analogous to that of pulse-echo ultrasound imaging; however light is used rather than sound to create the image. The case presented illustrates the 5-year follow-up examination after bare metal stent implantation (Figure 1). Intravascular ultrasound imaging (IVUS) shows concentric, moderate neointimal hyperplasia (Figure 2). Intravascular OCT provides detailed visualization of the individual stent struts, neointimal proliferation, and neovascularization that is missed by IVUS (Figure 3).

View larger version (66K): [in this window] [in a new window]   Figure 1. a, Baseline, June 1999: occluded right coronary artery (RCA); b, RCA after recanalization and bare metal stent implantation for postinfarct angina (proximal to distal: Multilink duet stent, 3.0/23 mm; AVE microstent, 3.0/39 mm; and Mini Crown stent, 2.5/15 mm); c, follow-up, October 2004: arrow indicates region imaged by OCT and IVUS.

View larger version (134K): [in this window] [in a new window]   Figure 2. IVUS image (40 MHz, Atlantis CVIS). This image shows a typical visualization of the luminal border, vessel layers, and bright presentation of stent struts (arrows). The neointima is not clearly distinguishable throughout the circumference. Note the high echogenicity of blood speckles due to flow limitation from the IVUS probe.

View larger version (87K): [in this window] [in a new window]   Figure 3. a, OCT image of a stented region at 5-year follow-up. Individual stent struts are represented as highly reflective structures with typical dorsal shadowing (arrowheads). The neointima is concentric, with a thickness between 230 and 300 µm. Neovascularization is recognizable in the deep layers of the neointima, at the luminal side of the stent struts in the 8 to 1 o’clock position. The diameter of the microvessels is <100 µm. b, Segment magnification (x5.4), demonstrating the neovascular bed.

Intraplaque hemorrhage through the neovascular bed is hypothesized to promote plaque growth. Although neovascularization, particularly when adjacent to stent struts, is a common finding in experimental animal models, to date only sparse data based on postmortem case reports are available in humans.¹ The incidence, distribution, and time course are unknown. Our findings present strong evidence for the visualization of neovascularization in a living patient, which cannot be achieved with any other in vivo imaging modality to date.

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	References

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1. Inoue K, Abe K, Ando K, Shirai S, Nishiyama K, Nakanishi M, Yamada T, Sakai K, Nakagawa Y, Hamasaki N, Kimura T, Nobuyoshi M, Miyamoto TA. Pathological analyses of long-term intracoronary Palmaz-Schatz stenting: is its efficacy permanent? Cardiovasc Pathol. 2004; 13: 109–115.[Medline] [Order article via Infotrieve]
   

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Regar, E. Articles by Serruys, P.W. Search for Related Content PubMed PubMed Citation Articles by Regar, E. Articles by Serruys, P.W. Related Collections Restenosis Catheter-based coronary interventions: stents Coronary imaging: angiography/ultrasound/Doppler/CC Other Vascular biology Related Article