Atypical “black hole” phenomenon after treatment of sirolimus stent restenosis with a paclitaxel-coated balloon

Vicente, José; Lukic, Antonela; Lopez, Nieves Gonzalo; Arroyo, José R. Ruiz

doi:10.4244/eijv7i12a231

Cited by 5 publications

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“…Several studies have reported adverse local effects at the vessel wall after DCB for patients presenting with ISR. 19,20 Furthermore, the long-term effective treatment modality for DES ISR has not been fully investigated. A previous OCT study about qualitative assessment of ISR reported that vascular response was poor in patients with a homogeneous neointima compared with those with a layered or heterogeneous pattern (29.5±11.9% vs. 42.2±15.7% and 46.3±12.9%, respectively; P<0.01).…”

Section: Clinical Outcomesmentioning

confidence: 99%

Different Neointimal Pattern in Early vs. Late In-Stent Restenosis and Clinical Outcomes After Drug-Coated Balloon Angioplasty　― An Optical Coherence Tomography Study ―

Lee

Jung

Kim

et al. 2018

Circ J

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Section: Clinical Outcomesmentioning

confidence: 99%

Different Neointimal Pattern in Early vs. Late In-Stent Restenosis and Clinical Outcomes After Drug-Coated Balloon Angioplasty　― An Optical Coherence Tomography Study ―

Lee

Jung

Kim

et al. 2018

Circ J

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“…However, in rare cases, DCB may induce adverse local effects at the vessel wall. Indeed, the occurrence of late acquired malapposition with aneurysm formation on IVUS 3 and a black-hole phenomenon on OCT 4 have been reported as exceedingly rare incidental findings at late follow-up after DCB treatment. However, to our knowledge, the presence of NA after DCB therapy has not been reported.…”

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confidence: 99%

Neoatherosclerosis After Paclitaxel-Coated Balloon Angioplasty for In-Stent Restenosis

et al. 2014

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I n-stent neoatherosclerosis (NA) has been reported after drug-eluting stent (DES) and bare-metal stent implantation.1 NA is not only more frequent but also occurs earlier in patients undergoing DES implantation compared with those treated with bare-metal stents.1 This phenomenon has major potential implications because complicated NA (mainly from rupture of a thin-cap fibroatheroma) may result in very late stent thrombosis.2 Although NA can be visualized using intravascular ultrasound (IVUS), optical coherence tomography (OCT), because of its unique resolution (15 μm), appears ideally suited to detect this phenomenon in vivo.2 We report on a patient treated with a drug-coated balloon (DCB) for recurrent in-stent restenosis (ISR) who at late follow-up developed NA as depicted by OCT and IVUS.A 52-year-old man required a paclitaxel-eluting stent implantation on the proximal left anterior descending coronary artery 2 years ago for unstable angina. Ten months later, an everolimus-eluting stent was implanted for ISR and, eventually, 4 months later surgery was required for recurrent ISR with a left internal mammary artery sequentially anastomosed to the left anterior descending coronary artery and to a diagonal branch. Presently, he was admitted for unstable angina, and coronary angiography revealed an occluded left internal mammary artery with just a string sign and faint filling of the diagonal branch. A critical ISR of the proximal left anterior descending coronary artery was demonstrated. After lesion predilation, IVUS and OCT revealed the presence of residual neointimal tissue with a classical homogeneous pattern, hyperechogenic on IVUS ( Figure 1A) and uniformly bright on OCT ( Figure 1B), and moderate DES underexpansion. Subsequently, a DCB (SeQuent Please; B. Braun Melsungen) was used (60 seconds) with a satisfactory final angiographic result. At 9 months follow-up, the patient was completely asymptomatic and the scheduled coronary angiography showed a mild lumen narrowing (30% diameter stenosis) at the same DES site. At this location, IVUS disclosed a hypoechogenic tissue (consistent with a black hole; Figure 2A and 2B) immediately distal to an area of hyperechogenic neointima with a layered pattern ( Figure 2C and 2D). OCT revealed that this dark tissue actually had a speckled pattern with brighter tiny spots ( Figure 3B and 3C), whereas a glistening bright tissue, with dorsal attenuation and marked shadowing of the stent struts, was depicted at the proximal site ( Figure 3D). Minimal lumen area was 3 mm 2 . The remaining DES segments showed just mild uniformly bright neointimal proliferation. The patient was discharged on medical therapy, including intensive lipid-lowering treatment.DCB are highly effective for patients presenting with ISR. In this setting, DCB are clearly superior to conventional balloon angioplasty and similar to first-generation DES. DCB elicit a dramatic inhibition of late neointimal response. However, in rare cases, DCB may induce adverse local effects at the vessel wall. Indeed, the ...

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Black hole restenosis after drug-eluting stent implantation for in-stent restenosis: potential mechanism and optimal strategy

et al. 2014

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In-stent restenosis (ISR) has long remained as the major limitation of coronary stenting. The use of drug-eluting stent (DES) reduces the risk of repeat revascularization without an increase of death and myocardial infarction, compared to the standard bare metal stents. DES has also demonstrated markedly to reduce ISR for complex lesions. However, ISR after DES implantation still occurs and optimal treatment for ISR after DES has not been established. Herein, we report 3 cases with black hole restenosis confirmed by intravascular ultrasound at the site of overlapped DES and discuss potential mechanism and optimal strategy for this phenomenon.

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Atypical “black hole” phenomenon after treatment of sirolimus stent restenosis with a paclitaxel-coated balloon

Cited by 5 publications

References 2 publications

Different Neointimal Pattern in Early vs. Late In-Stent Restenosis and Clinical Outcomes After Drug-Coated Balloon Angioplasty　― An Optical Coherence Tomography Study ―

Different Neointimal Pattern in Early vs. Late In-Stent Restenosis and Clinical Outcomes After Drug-Coated Balloon Angioplasty　― An Optical Coherence Tomography Study ―

Neoatherosclerosis After Paclitaxel-Coated Balloon Angioplasty for In-Stent Restenosis

Black hole restenosis after drug-eluting stent implantation for in-stent restenosis: potential mechanism and optimal strategy

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Atypical “black hole” phenomenon after treatment of sirolimus stent restenosis with a paclitaxel-coated balloon

Cited by 5 publications

References 2 publications

Different Neointimal Pattern in Early vs. Late In-Stent Restenosis and Clinical Outcomes After Drug-Coated Balloon Angioplasty ― An Optical Coherence Tomography Study ―

Different Neointimal Pattern in Early vs. Late In-Stent Restenosis and Clinical Outcomes After Drug-Coated Balloon Angioplasty ― An Optical Coherence Tomography Study ―

Neoatherosclerosis After Paclitaxel-Coated Balloon Angioplasty for In-Stent Restenosis

Black hole restenosis after drug-eluting stent implantation for in-stent restenosis: potential mechanism and optimal strategy

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Different Neointimal Pattern in Early vs. Late In-Stent Restenosis and Clinical Outcomes After Drug-Coated Balloon Angioplasty　― An Optical Coherence Tomography Study ―

Different Neointimal Pattern in Early vs. Late In-Stent Restenosis and Clinical Outcomes After Drug-Coated Balloon Angioplasty　― An Optical Coherence Tomography Study ―