True Three-Dimensional Reconstructed Images Showing Lumen Enlargement After Sirolimus-Eluting Stent Implantation
A 69-year-old woman with stable angina pectoris was enrolled in the randomized, double-blind RAndomized study with the sirolimus-eluting VElocity balloon-expandable stent in the treatment of patients with de novo native coronary artery Lesions (RAVEL) trial. Coronary angiography revealed a proximal stenosis in the left circumflex coronary artery (Figure 1A). A 3.0×18 mm sirolimus-eluting Bx VELOCITY stent (Cordis Corp, Johnson & Johnson) was implanted with a satisfactory result (Figure 1B). Intravascular ultrasound (IVUS) images were then obtained with ECG-gated pullback, showing stent struts well apposed to the vessel wall (Figure 1D). At 6-month follow-up, angiography showed no restenosis (Figure 1C), whereas IVUS images revealed good stent apposition with minimal neointimal hyperplasia and some tissue disappearance between stent struts (Figure 1E and 1F). To further evaluate these observations, we combined biplane angiography and IVUS (ANGUS) for a true 3-dimensional reconstruction of the stented region. Figure 2 shows the intimal thickness color-coded on the stent surface. The blue area seen on the proximal stent surface after the procedure (Figure 2A and 2B) relates to a side branch. The images at follow-up (Figure 2C and 2D) identify additional blue areas, indicating disappearance of tissue between stent struts and lumen enlargement. Localized neointimal hyperplasia (red area) was also observed. In addition, there are small changes in 3D stent shape. In the RAVEL trial, the late loss averaged −0.01±0.33 mm, consistent with the presence of lumen enlargement in some patients.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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