Mechanisms of balloon angioplasty and repeat stenting in patients with drug-eluting in- stent restenosis Fernando Alfonso, Jorge Sandoval, María J. Pérez-Vizcayno,

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Presentation transcript:

Mechanisms of balloon angioplasty and repeat stenting in patients with drug-eluting in- stent restenosis Fernando Alfonso, Jorge Sandoval, María J. Pérez-Vizcayno, Alberto Cárdenas, Nieves Gonzalo, Pilar Jiménez-Quevedo, Borja Ibáñez, Iván Núñez-Gil, Fernando Rivero, Javier Escaned, Antonio Fernández-Ortíz, Carlos Macaya International Journal of Cardiology Volume 178, Pages 213-220 (January 2015) DOI: 10.1016/j.ijcard.2014.10.139 Copyright © 2014 Terms and Conditions

Fig. 1 OCT and IVUS findings: Baseline, after BA and after DES. Top: OCT images. Bottom: IVUS images. A) Before intervention a homogeneous bright neointimal hyperplasia is visualized on OCT. A') IVUS also detects the neointimal growth but the lumen–neointima boundary is poorly delineated (arrows). Alternatively, the outer vessel boundary (external elastic lamina) is readily depicted. B) After balloon angioplasty deep dissections (arrows) are clearly visualized by OCT (injury score 4). B') IVUS detects lumen enlargement and a minor neointimal dissection (arrow) following balloon dilation. C) After repeat DES implantation OCT shows excellent results and adequate strut apposition with a minor residual dissection (arrow) prolapsing through the stent struts. In some areas a double strut layer is clearly recognized. C') IVUS image with satisfactory results after DES. (*)=wire artifact. International Journal of Cardiology 2015 178, 213-220DOI: (10.1016/j.ijcard.2014.10.139) Copyright © 2014 Terms and Conditions

Fig. 2 OCT and IVUS findings. Top: OCT images. Bottom: IVUS images. A) Baseline OCT findings with severe neointimal hyperplasia showing a heterogeneous pattern, microvessels and some lumen irregularities (arrow). A') IVUS showing severe neointimal hyperplasia and severe stent underexpansion. B) After aggressive balloon dilation 2 deep dissections (arrows) are detected by OCT (injury score 4). B') After dilation IVUS only detected some residual neointima with unclear borders. C) Following DES implantation OCT visualized excellent results with 2 minor intrastent dissections (injury score 2). C') IVUS image after DES. (*)=wire artifact. International Journal of Cardiology 2015 178, 213-220DOI: (10.1016/j.ijcard.2014.10.139) Copyright © 2014 Terms and Conditions

Fig. 3 OCT and IVUS during intervention. Top: OCT images. Bottom: IVUS images. A) OCT showing significant eccentric neointimal hyperplasia with a heterogeneous pattern. A') Baseline IVUS. B) OCT after balloon dilation showing 2 dissections (arrows) (injury score 3). B') After dilation IVUS only visualized some residual neointima (arrows). C) Excellent OCT findings after DES. Notice the double stent layer. C') Final IVUS after DES. (*)=wire artifact. International Journal of Cardiology 2015 178, 213-220DOI: (10.1016/j.ijcard.2014.10.139) Copyright © 2014 Terms and Conditions

Fig. 4 Images immediately outside the stent edge in a patient with proliferative in-stent restenosis: Top: OCT images. Bottom: IVUS images. A) OCT findings showing the plaque causing lumen narrowing. A') IVUS allows visualization of the total plaque burden. B) After predilation 2 clear edge-dissections (arrows) (injury score 3) were detected. B') IVUS only was able to detect the largest dissection (arrow). C) After DES implantation some tissue protrusion and 1 tiny intrastent dissection were detected. Notice the single stent layer of the new DES that extended outside the previous DES. C') Final IVUS findings. (*)=wire artifact. International Journal of Cardiology 2015 178, 213-220DOI: (10.1016/j.ijcard.2014.10.139) Copyright © 2014 Terms and Conditions