Restenosis of a Polytetrafluoroethylene-Covered Stent Visualized by Coronary Angioscopy and Optical Coherence Tomography: A Case Report

Abstract

An expandable polytetrafluoroethylene (PTFE)-covered stent graft is beneficial for the treatment of coronary perforations. However, several reports have shown that restenosis and thrombotic occlusion occasionally occur in the stented segment after PTFE-covered stent implantation. A restenosis case after treatment with PTFE-covered stent against saphenous vein graft (SVG) perforation has never been evaluated with optical coherence tomography (OCT) or coronary angioscopy (CAS). This case report presents a 75-year-old man treated with a PTFE-covered stent after he suffered from SVG perforation 6 months ago. He was found to have a focal restenosis of the distal edge of the PTFE-covered stent and underwent percutaneous coronary intervention. OCT showed focal restenosis with homogeneous neointima and exposed struts in the middle and proximal part of the PTFE-covered stent. CAS showed white neointima with a smooth surface at the restenosis site and a sharp border against proximal exposed struts with characteristic links. This case study showed, for the first time in vivo and in a human, the neointimal characteristics of restenosis and uncovered stent struts in a PTFE-covered stent which had been implanted 6 months before. The delayed endothelialization was sustained until 12 months after implantation.

Keywords

percutaneous coronary intervention - polytetrafluoroethylene-covered stent - case study - coronary angioscopy - optical coherence tomography - PCI - OCT

• References

• 1 Ajluni SC, Glazier S, Blankenship L, O'Neill WW, Safian RD. Perforations after percutaneous coronary interventions: clinical, angiographic, and therapeutic observations. Cathet Cardiovasc Diagn 1994; 32 (03) 206-212
• 2 Gruberg L, Pinnow E, Flood R. , et al. Incidence, management, and outcome of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol 2000; 86 (06) 680-682 , A8
• 3 Javaid A, Buch AN, Satler LF. , et al. Management and outcomes of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol 2006; 98 (07) 911-914
• 4 Shimony A, Zahger D, Van Straten M. , et al. Incidence, risk factors, management and outcomes of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol 2009; 104 (12) 1674-1677
• 5 Campbell PG, Hall JA, Harcombe AA, de Belder MA. The Jomed Covered Stent Graft for coronary artery aneurysms and acute perforation: a successful device which needs careful deployment and may not reduce restenosis. J Invasive Cardiol 2000; 12 (05) 272-276
• 6 Gercken U, Lansky AJ, Buellesfeld L. , et al. Results of the Jostent coronary stent graft implantation in various clinical settings: procedural and follow-up results. Catheter Cardiovasc Interv 2002; 56 (03) 353-360
• 7 Danenberg HD, Shauer A, Gilon D. Very late coronary stent graft thrombosis after aspirin cessation. Int J Cardiol 2007; 120 (01) e15-e17
• 8 Takano M, Ohba T, Inami S, Seimiya K, Sakai S, Mizuno K. Angioscopic differences in neointimal coverage and in persistence of thrombus between sirolimus-eluting stents and bare metal stents after a 6-month implantation. Eur Heart J 2006; 27 (18) 2189-2195
• 9 Takano M, Yamamoto M, Inami S. , et al. Long-term follow-up evaluation after sirolimus-eluting stent implantation by optical coherence tomography: do uncovered struts persist?. J Am Coll Cardiol 2008; 51 (09) 968-969
• 10 Takano M, Yamamoto M, Inami S. , et al. Delayed endothelialization after polytetrafluoroethylene-covered stent implantation for coronary aneurysm. Circ J 2009; 73 (01) 190-193
• 11 Veselka J, Tesar D, Honek T, Burkert J. Treatment of recurrent coronary rupture by implantation of three coronary stent-grafts. Int J Cardiovasc Intervent 2003; 5 (02) 88-91
• 12 Keeley EC, Velez CA, O'Neill WW, Safian RD. Long-term clinical outcome and predictors of major adverse cardiac events after percutaneous interventions on saphenous vein grafts. J Am Coll Cardiol 2001; 38 (03) 659-665
• 13 Stone GW, Goldberg S, O'Shaughnessy C. , et al. 5-year follow-up of polytetrafluoroethylene-covered stents compared with bare-metal stents in aortocoronary saphenous vein grafts the randomized BARRICADE (barrier approach to restenosis: restrict intima to curtail adverse events) trial. JACC Cardiovasc Interv 2011; 4 (03) 300-309
• 14 Crombez M, Chevallier P, Gaudreault RC, Petitclerc E, Mantovani D, Laroche G. Improving arterial prosthesis neo-endothelialization: application of a proactive VEGF construct onto PTFE surfaces. Biomaterials 2005; 26 (35) 7402-7409