Neoatherosclerosis causing edge in-stent restenosis: optical coherence tomography findings

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Imaging

Background:

• In-stent restenosis (ISR) remains a challenge after coronary artery interventions.
• Edge ISR, occurring at the stent margins, presents unique diagnostic and therapeutic considerations.
• Bare-metal stents, while durable, can still develop late complications like restenosis.

Purpose of the Study:

• To describe a unique case of late-presenting edge in-stent restenosis (ISR).
• To illustrate the utility of optical coherence tomography (OCT) in diagnosing the underlying cause of edge ISR.
• To review current therapeutic strategies for edge ISR.

Main Methods:

• A case report of a patient with a 12-year-old bare-metal stent.
• Utilized optical coherence tomography (OCT) for detailed imaging of the stented segment and its edges.
• Reviewed existing literature on edge ISR and its management.

Main Results:

• Optical coherence tomography (OCT) identified ruptured neoatherosclerosis at the edge of the bare-metal stent.
• This finding explains the mechanism of late edge ISR in this patient.
• The case underscores the importance of advanced imaging in understanding complex ISR.

Conclusions:

• Edge in-stent restenosis (ISR) can occur late after bare-metal stent implantation.
• Optical coherence tomography (OCT) is crucial for elucidating the specific anatomic substrate of edge ISR, such as ruptured neoatherosclerosis.
• Optimal therapy for edge ISR requires careful consideration of imaging findings and patient factors.