Abstract
A 74-year-old woman presented with effort-induced chest pain. Diagnostic coronary angiography revealed three-vessel disease. A successful angioplasty was performed with two sirolimus-eluting stents placed in the left anterior descending artery (LAD) and left circumflex artery (LCX). The right coronary artery (RCA) was treated with a bare-metal stent. Follow-up angiography and intravascular ultrasound (IVUS) assessment were performed 8 months later, which showed late stent malapposition (LSM) with marked positive vascular remodeling around the drug-eluting stents (DES) in both LAD and LCX lesions, but there was no evidence of ectatic area around the BMS in the RCA lesion. Compared with the baseline IVUS, a significant increase in external elastic membrane (EEM) cross-sectional area was found. Twenty-seven months later, we performed repeat follow-up angiography. Intravascular ultrasound still showed vessel malapposition. A previous report showed that aneurysmal dilatation of the stented segment with severe localized hypersensitivity reaction could be a potential cause of late thrombosis after DES implantation. If LSM is related to hypersensitivity of the DES, it may have a potential risk of adverse events. Although there is a paucity of data regarding malapposition as the cause of adverse events, careful long-term follow-up of patients with vessel enlargement after DES placement is recommended.
Similar content being viewed by others
References
Hong MK, Mintz GS, Lee CW, Kim YH, Lee SW, Song JM, Han KH, Kang DH, Song JK, Kim JJ, Park SW, Park SJ (2004) Incidence, mechanism, predictors, and long-term prognosis of late stent malapposition after bare-metal stent implantation. Circulation 109:881–886
Serruys PW, Degertekin M, Tanabe K, Abizaid A, Sousa JE, Colombo A, Guagliumi G, Wijns W, Lindeboom WK, Ligthart J, de Feyter PJ, Morice MC (2002) Intravascular ultrasound findings in the multicenter, randomized, double-blind RAVEL (RAndomized study with the sirolimus-eluting VElocity balloon-expandable stent in the treatment of patients with de novo native coronary artery Lesions) trial. Circulation 106:798–803
Cook S, Wenaweser P, Togni M, Billinger M, Morger C, Seiler C, Vogel R, Hess O, Meier B, Windecker S (2007) Incomplete stent apposition and very late stent thrombosis after drug-eluting stent implantation. Circulation 115:2426–2434
Mintz GS, Weissman NJ, Fitzgerald PJ (2001) Intravascular ultrasound assessment of the mechanisms and results of brachytherapy. Circulation 104:1320–1325
Shah VM, Mintz GS, Apple S, Weissman NJ (2002) Background incidence of late malapposition after bare-metal stent implantation. Circulation 106:1753–1755
Tanabe K, Serruys PW, Degertekin M, Grube E, Guagliumi G, Urbaszek W, Bonnier J, Lablanche JM, Siminiak T, Nordrehaug J, Figulla H, Drzewiecki J, Banning A, Hauptmann K, Dudek D, Bruining N, Hamers R, Hoye A, Ligthart JM, Disco C, Koglin J, Russell ME, Colombo A (2005) Incomplete stent apposition after implantation of paclitaxel-eluting stents or bare metal stents: insights from the randomized TAXUS II trial. Circulation 111: 900–905
Hong MK, Mintz GS, Lee CW, Park DW, Park KM, Lee BK, Kim YH, Song JM, Han KH, Kang DH, Cheong SS, Song JK, Kim JJ, Park SW, Park SJ (2006) Late stent malapposition after drugeluting stent implantation: an intravascular ultrasound analysis with long-term follow-up. Circulation 113:414–419
Shah VM, Mintz GS, Apple S, Weissman NJ (2002) Background incidence of late malapposition after bare-metal stent implantation. Circulation 106:1753–1755
Mintz GS, Shah VM, Weissman NJ (2003) Regional remodeling as the cause of late stent malapposition. Circulation 107:2660–2663
Virmani R, Guagliumi G, Farb A, Musumeci G, Grieco N, Motta T, Mihalcsik L, Tespili M, Valsecchi O, Kolodgie FD (2004) Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent: should we be cautious? Circulation 109: 701–705
Marx SO, Marks AR (2001) Bench to bedside: the development of rapamycin and its application to stent restenosis. Circulation 104:852–855
Ozer N, Tangurek B, Firat F, Ozer S, Tartan Z, Ozturk R, Ozay B, Yilimaz H, Cam N (2008) Effects of drug-eluting stents on systemic inflammatory response in patients with unstable angina pectoris undergoing percutaneous coronary intervention. Heart Vessels 23:75–82
Nebeker JR, Virmani R, Bennett CL, Hoffman JM, Samore MH, Alvarez J, Davidson CJ, McKoy JM, Raisch DW, Whisenant BK, Yarnold PR, Belknap SM, West DP, Gage JE, Morse RE, Gligoric G, Davidson L, Feldman MD (2006) Hypersensitivity cases associated with drug-eluting coronary stents: a review of available cases from the Research on Adverse Drug Events and Reports (RADAR) project. J Am Coll Cardiol 47:175–181
Weissman NJ, Koglin J, Cox DA, Hermiller J, O’shaughnessy C, Mann JT, Turco M, Caputo R, Bergin P, Greenberg J, Kutcher M, Wong SC, Strickland W, Mooney M, Russell ME, Ellis SG, Stone GW (2005) Polymer-based paclitaxel-eluting stents reduce in-stent neointimal tissue proliferation: a serial volumetric intravascular ultrasound analysis from the TAXUS-IV trial. J Am Coll Cardiol 45:1201–1205
Degertekin M, Serruys PW, Tanabe K, Lee CH, Sousa JE, Colombo A, Morice MC, Ligthart JM, de Feyter PJ (2003) Long-term followup of incomplete stent apposition in patients who received sirolimus-eluting stent for de novo coronary lesions: an intravascular ultrasound analysis. Circulation 108:2747–2750
Azarbal B, Currier JW (2006) Allergic reactions after the implantation of drug-eluting stents J Am Coll Cardiol 47:182–183
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Watanabe, Y., Asano, R., Hata, N. et al. Late stent malapposition with marked positive vascular remodeling observed only at the site of drug-eluting stents after multivessel coronary stenting. Heart Vessels 24, 308–312 (2009). https://doi.org/10.1007/s00380-008-1124-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00380-008-1124-z