Frequency-domain optical coherence tomography assessment of very late vascular response after carotid stent implantation Guilherme F. Attizzani, MD,

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Presentation transcript:

Frequency-domain optical coherence tomography assessment of very late vascular response after carotid stent implantation Guilherme F. Attizzani, MD, Michael R. Jones, MD, Curtis A. Given, MD, William H. Brooks, MD, Hiram G. Bezerra, MD, PhD, Marco A. Costa, MD, PhD Journal of Vascular Surgery Volume 58, Issue 1, Pages 201-204 (July 2013) DOI: 10.1016/j.jvs.2012.11.038 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 Layered low signal intensity (LSI) vascular response very late after carotid stent implantation. A, Angiogram demonstrates in-stent (stent contour is highlighted by the blue dashed lines) restenosis in the right common carotid artery (white arrow). B, The restenotic segment can be seen in the longitudinal view of frequency-domain optical coherence tomography image. The numbered red dashed circles correspond to the numbered cross-sections (1-6). A normal-appearing, high signal intensity stent strut coverage pattern is revealed in 1, whereas in 2 a LSI pattern of coverage and organized thrombus (white arrow) are demonstrated. Similar LSI layered stent coverage pattern is visualized in 3 with the presence of intraluminal thrombus (white arrow). In 4, LSI coverage coupled with organized thrombus prevents adequate visualization of stent struts. The most restenotic cross-section, which exhibits a clearly layered LSI tissue covering the stent struts, is depicted in 5. More proximally, although a normal stent coverage pattern (ie, high signal intensity) can be visualized in part of the cross-section, LSI tissue is still present (white asterisk). Journal of Vascular Surgery 2013 58, 201-204DOI: (10.1016/j.jvs.2012.11.038) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 Image shows massive low signal intensity (LSI) tissue prolapse after carotid stenting for the treatment of in-stent restenosis. A, Two layers of stent struts are visualized revealing minimal tissue prolapse. B and C, Marked tissue prolapse of layered LSI stent strut coverage is demonstrated (white arrows). Journal of Vascular Surgery 2013 58, 201-204DOI: (10.1016/j.jvs.2012.11.038) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 Image shows in-stent lipid-laden neointimal hyperplasia with inflammation and two sites of plaque rupture. A, The carotid angiogram demonstrates a filling defect in the right internal carotid artery, suggestive of thrombus (black arrow). B, Six weeks after antiplatelet and antithrombin therapy, the filling defect is almost completely resolved. C, Frequency-domain optical coherence tomography assessment demonstrates a pattern of stent strut coverage that leads to marked light attenuation without clear borders, suggestive of lipid-laden neointima (white asterisks), which prevents adequate visualization of stent struts (white arrowheads). D, The longitudinal view of frequency-domain optical coherence tomography shows a site of plaque rupture (white arrow). E, Two different sites of intrastent plaque rupture without overlying thrombus (white arrows) and diffuse lipid-laden neointima (white asterisks) are depicted. F, The bright spots visualized in a ruptured fibrous cap (red arrows) might correspond to macrophage infiltration, while the white arrowhead shows a stent strut embedded in lipid-laden neointima. Journal of Vascular Surgery 2013 58, 201-204DOI: (10.1016/j.jvs.2012.11.038) Copyright © 2013 Society for Vascular Surgery Terms and Conditions