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Updated: Jun 3, 2026
Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model
Published on: September 14, 2009
Subacute drug-eluting stent thrombosis caused by stent underexpansion: evaluation by optical coherence tomography
Roberto Martín-Reyes1, Santiago Jiménez-Valero, Felipe Navarro
1Interventional Cardiology Unit, Fundación Jiménez Díaz University Hospital, Avenida Reyes Católicos 2, 28040 Madrid, Spain.
Insights
Subacute drug-eluting stent thrombosis caused ST segment elevation myocardial infarction. Optical coherence tomography revealed stent underexpansion as the cause, guiding percutaneous coronary intervention.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Imaging
Background:
- Drug-eluting stents (DES) are crucial for treating coronary artery disease.
- Stent thrombosis remains a significant complication, necessitating improved diagnostic tools.
- Percutaneous coronary intervention (PCI) techniques continue to evolve.
Observation:
- A patient developed ST segment elevation myocardial infarction (STEMI) due to subacute stent thrombosis in the left circumflex artery (LCX).
- The thrombosis occurred in the overlapping segment of two DES implanted to treat a chronic total occlusion.
- Optical coherence tomography (OCT) identified stent underexpansion as the primary cause.
Findings:
- OCT imaging clearly demonstrated stent underexpansion in the overlapping DES segment, pinpointing it as the mechanism for early stent thrombosis.
- The Imagewire, an OCT guidewire, successfully navigated severe stenosis caused by underexpansion, unlike an intravascular ultrasound (IVUS) catheter.
- This case highlights OCT's utility in elucidating stent thrombosis mechanisms and informing PCI strategies.
Implications:
- OCT can be instrumental in diagnosing the root causes of stent thrombosis, enabling tailored treatment adjustments.
- The findings underscore the importance of precise stent deployment and post-procedural assessment to prevent complications.
- Advanced imaging modalities like OCT offer superior visualization for complex PCI cases, potentially improving patient outcomes.
Abstract:
We present the case report of a patient presenting with ST segment elevation myocardial infarction due to a subacute drug-eluting stent trombosis within the proximal segment of the left circumflex artery (LCX). Six days before a total chronic occlusion was treated at the mid segment of the LCX by overlapping two drug-eluting stents. Optical coherence tomography (OCT) was helpful to demonstrate stent underexpansion of the overlaping segment as the main mechanism of early stent thrombosis. This case is illustrative about the potential role of OCT to identify the mechanisms of ST and thus guiding the PCI procedure. Moreover, our case shows the capability of the Imagewire to cross a severe stenosis due to stent underexpansion that could not be crossed by the IVUS catheter.
