PMC2773428_01
Consecutive coronary angiograms are shown in the LAO view. (a) Tight, thrombotic lesion (arrow) of the angulated part of the LAD artery. (b) Good angiographic result is achieved after implantation of a 2.5 x 18 mm sirolimus-eluting stent. (c) Thrombotic occlusion (arrow) 9 months after the stent implantation. (d) Final angiographic result after successive inflations of a 3.0 x 20 mm noncompliant balloon.
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fig1
Angiography revealed a tight thrombotic lesion of the proximal LAD with a TIMI grade 2 blood flow (Figure 1(a)). The angiographic control showed a good result (Figure 1(b)) and, as a result, no attempt was made to expand the stent with a noncompliant balloon. The repeat angiography showed a thrombotic occlusion of the implanted stent (Figure 1(c)).
IVUS images of the LAD artery beyond the proximal (a) and distal borders (b) of the stented segment are shown after the occlusive thrombus was mechanically removed. A large and predominantly fibrous plaque (arrows) narrows the vessel lumen particularly at distal site.
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fig2
The proximal LAD showed a positive vessel wall remodeling with maximum diameters within the external elastic membrane (EEM) at both stent borders of 4.5 mm and 3.5 mm, respectively (Figures 2(a), 2(b)). The final angiographic result appeared excellent (Figure 2(d)) and, therefore, the PCI was completed without additional stent placement.
Successive IVUS images of the LAD artery from proximal (a) to distal part (d) of the fractured stent are shown after the occlusive thrombus was mechanically removed. (a) Complete, transverse fracture is seen with a spiral distortion of stent struts (parallel arrows). (b) Stent gap with totally missing struts. (c) Re-appearance of a few struts (orthogonal arrows). (d) Intact distal part of the stent.
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fig3
Near the distal part of the implanted stent, a severe stent fracture (SF) was found with complete strut separation over a wide distance (Figures 3(a)-3(d)).