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

Abstract

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.

The Best Strategy for the Black Hole Phenomenon between Intravascular Ultrasound and Optical Coherence Tomography

“…Tissue analysis of the BH revealed a primarily hypocellular matrix with areas rich in proteoglycans, possibly due to delayed vascular wound healing following SES implantation. The echolucent appearance was likely attributed to this hypocellular matrix and its high water content [9,10].…”

“…However, ISR after DES implantation still occurs [5,6]. The black hole (BH) phenomenon is when an intraluminal restenotic lesion image is obtained by intravascular ultrasound (IVUS) and optical coherence tomography (OCT) [7][8][9][10][11][12]. The development of ISR involves multiple factors, including biological, mechanical, and patient-and operator-related factors [13][14][15].…”

The Best Strategy for Black Hole Phenomenon between Intravascular Ultrasound and Optical Coherence Tomography

“…However, ISR after DES implantation still occurs [5,6]. The black hole (BH) phenomenon is when an intraluminal restenotic lesion image is obtained by intravascular ultrasound (IVUS) and optical coherence tomography (OCT) [7][8][9][10][11][12]. The development of ISR involves multiple factors, including biological, mechanical, and patient-and operator-related factors [13][14][15].…”