DOI:

False lumen stenting: uncommon stent occlusion demonstrated by intravascular ultrasound

Shinichi Furuichi*, MD; Davide Tavano, MD; Altin Palloshi, MD; Antonio Colombo, MD

A 53-year-old man with hypertension and hyperlipidaemia was referred to our hospital for a third attempt to recanalise an occlusive in-stent restenosis (ISR) in the circumflex artery (LCX). In 2003, the patient had inferolateral myocardial infarction with a triple-vessel disease. Coronary bypass grafting was performed. In March 2006, stress scintigraphy for screening showed lateral ischaemia. Coronary angiography revealed an occlusion of the right internal mammary artery to a posterolateral branch. In another centre, coronary intervention was performed for subtotal occlusion in the LCX (Figure 1A). During the procedure a guidewire entered a false lumen (Figure 1B) and finally two bare metal stents were implanted with distal TIMI 2 flow (Figure 1C). Four months later, an occlusive restenosis was found. Two previous attempts failed to reopen the vessel.

Figure 1. Initial coronary intervention for a subtotal occlusion in the LCX.

Control angiography showed occlusive ISR (Figure 2A). After crossing a guidewire and predilatation (Figure 2B), IVUS demonstrated that the distal stent was completely positioned in the false lumen and the guidewire re-entered the true lumen 18 mm distal to the stent distal edge. (Figure 2a-e).

Figure 2. Control angiography with IVUS revealing occlusive in-stent restenosis.

The true lumen (*) was observed out of stent struts. Angiography with IVUS transducer positioned at the re-entry point (Figure 3A, arrow) was performed for a guide to optimal stenting and three sirolimus eluting stents (SES) were implanted with excellent angiographic result (Figure 3B). Post-intervention IVUS confirmed SES covered entire false lumen and connected the proximal true lumen with the distal one. The vessel was open at four months follow-up (Figure 3C).

Figure 3. Coronary angiography with implantation of 3 sirolimus-eluting stents.

Volume 4 Number 2
Aug 20, 2008
Volume 4 Number 2
View full issue


Key metrics

Suggested by Cory

Flashlight

10.4244/EIJ-D-24-01058 Jun 2, 2025
AMAC: Anchor the Mother to Advance the Child – a technique for complex PCI
Cocco N et al

Editorial

10.4244/EIJ-E-25-00018 Jun 2, 2025
Using pericoronary fat attenuation to guide management after coronary interventions
Antoniades C and Chan K
free

Editorial

10.4244/EIJ-E-25-00014 Jun 2, 2025
Polymer-free biolimus-eluting stents: there is no such thing as a free lunch
Piccolo R and Spitzer E
free
Trending articles
309.93

State-of-the-Art Review

10.4244/EIJ-D-21-00695 Nov 19, 2021
Transcatheter treatment for tricuspid valve disease
Praz F et al
free
166.7

Expert review

10.4244/EIJ-D-21-00690 May 15, 2022
Crush techniques for percutaneous coronary intervention of bifurcation lesions
Moroni F et al
free
92.45

State-of-the-Art Review

10.4244/EIJ-D-20-01296 Aug 27, 2021
Management of cardiogenic shock
Thiele H et al
free
76

State-of-the-Art

10.4244/EIJ-D-23-00840 Sep 2, 2024
Aortic regurgitation: from mechanisms to management
Baumbach A et al
free
72.85

State-of-the-Art

10.4244/EIJ-D-24-00386 Feb 3, 2025
Mechanical circulatory support for complex, high-risk percutaneous coronary intervention
Ferro E et al
free
58.3

Clinical research

10.4244/EIJ-D-23-00344 Sep 18, 2023
Clinical outcomes of TAVI with the Myval balloon-expandable valve for non-calcified aortic regurgitation
Sanchez-Luna JP et al
free
56.65

Clinical research

10.4244/EIJ-D-20-01155 Oct 20, 2021
A deep learning algorithm for detecting acute myocardial infarction
Liu W et al
free
33.9

CLINICAL RESEARCH

10.4244/EIJ-D-17-00381 Oct 11, 2017
Stent malapposition and the risk of stent thrombosis: mechanistic insights from an in vitro model
Foin N et al
free
33.65

State-of-the-Art

10.4244/EIJ-D-23-00606 Jan 1, 2024
Targeting inflammation in atherosclerosis: overview, strategy and directions
Waksman R et al
free
X

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

EuroPCR EAPCI
PCR ESC
Impact factor: 7.6
2023 Journal Citation Reports®
Science Edition (Clarivate Analytics, 2024)
Online ISSN 1969-6213 - Print ISSN 1774-024X
© 2005-2025 Europa Group - All rights reserved