Acute Coronary Syndrome due to In-Stent Neoatherosclerosis 14 years after Bare-Metal Stent Implantation: Findings of Intravascular Imaging Modalities

TL;DRAbstract

In recent years, neoatherosclerosis and very late stent thrombosis in the extended follow-up period after baremetal stent (BMS) implantation have been recognized. We experienced a case of in-stent restenosis (ISR) detected in a BMS implanted 14 years prior. An 86-year-old man who had a history of BMS implantation because of angina pectoris in the proximal left anterior descending coronary artery (LAD) 14 years previously was referred to our hospital because of worsening chest pain on exertion for 1 month. A coronary angiogram revealed severe stenosis in the previously implanted BMS. Seven days later, percutaneous coronary intervention (PCI) for the LAD lesion was performed. Prior to intervention, intravascular ultrasound (IVUS), optical coherence tomography (OCT), and intracoronary angioscopy were performed, which showed diffuse heterogeneous plaque throughout the stent, various types of imaging in plaques including thrombi and fibrous plaque, and yellow plaques with respective imaging

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