Chronic thrombus occlusion after bare metal stenting in a patient with acute coronary syndrome visualized by optical...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Bare metal stent (BMS) implantation is a common treatment for acute coronary syndrome.
• In-stent restenosis (ISR) remains a clinical challenge following BMS implantation.
• Distinguishing between neo-intimal hyperplasia and thrombus is crucial for effective ISR management.

Purpose of the Study:

• To present a case of chronic thrombus occlusion causing restenosis after BMS implantation.
• To evaluate the utility of optical coherence tomography (OCT) in characterizing ISR lesions.
• To investigate the pathological nature of the occlusive material.

Main Methods:

• A 74-year-old male patient with acute coronary syndrome underwent BMS implantation.
• Serial coronary angiography and optical coherence tomography (OCT) were performed.
• Tissue retrieved during repeat percutaneous coronary intervention (PCI) underwent pathological and immunological staining.

Main Results:

• Coronary angiography at 6 months revealed sub-total occlusion proximal to the BMS.
• OCT imaging demonstrated an organized thrombus-like appearance with micro-channels.
• Pathological examination confirmed organized fibrin thrombus with angiogenesis, positive for CD68 and CD34, suggesting chronic organization.

Conclusions:

• Chronic organized thrombus can be a cause of restenosis after BMS implantation.
• Optical coherence tomography (OCT) is valuable in differentiating chronic thrombus from neo-intimal hyperplasia in ISR.
• This case highlights the importance of advanced imaging for accurate ISR diagnosis and management.