IMAGE IN CARDIOLOGY

DOI: 10.4244/EIJV12I10A201

Ruptured “non-culprit” in-stent neoatherosclerosis during ST-segment elevation acute myocardial infarction

Javier Cuesta, MD; Fernando Rivero, MD; Teresa Bastante, MD; Amparo Benedicto, MD; Fernando Alfonso*, MD

A 53-year-old man, with previous bare metal stent (BMS) implantation in the left circumflex (LCX) coronary artery 10 years ago (Panel A, yellow arrows), was admitted with a large anterior ST-segment elevation acute myocardial infarction (STEMI). Urgent coronary angiography showed a total occlusion of the left anterior descending (LAD) coronary artery (Panel B, white arrow) and also a severe in-stent restenosis (ISR) in the LCX (Panel B and Panel C, yellow arrows). A drug-eluting stent (DES) was implanted successfully in the LAD (Panel C, white arrows). Three days later a new coronary angiography was performed in order to treat the ISR in the LCX. Optical coherence tomography (OCT) revealed the presence of complicated neoatherosclerosis, with a glistening neointima with dark areas consistent with lipid pools (Panel D-Panel I, +) and several ruptured and ulcerated plaques, associated with an intracoronary red thrombus (Panel E-Panel I, yellow arrow and T). A bioresorbable vascular scaffold was successfully implanted.

Some previous studies have reported the association between in-stent neoatherosclerosis and progression of native coronary atherosclerosis. A pan-inflammatory process might be implicated. To the best of our knowledge, the presence of ruptured and complicated neoatherosclerosis in a “non-culprit” remote vessel in patients presenting with STEMI has not been reported previously.

Conflict of interest statement

The authors have no conflicts of interest to declare.

Volume 12 Number 10
Nov 20, 2016
Volume 12 Number 10
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