Neoatherosclerosis in Very Late Stenosis of Bare Metal Stent by Optical Coherence Tomography

Figure 1

(a) Coronary angiography showing a severe stenosis within the stent as well as luminal contour suggestive of plaque rupture more distally (asterisk). An L-mode OCT confirms severe luminal stenosis. (b) OCT showing neoatherosclerosis with lipid pools and a well-defined heterogenous low signal area of fibrocalcific deposits (arrow) within the previous stent. (c) Microvessels (arrow) within fibrotic neointimal tissue. (d) Intrastent ruptured plaque with disrupted fibrous cap and evacuated core. Active macrophage infiltration is also noted with punctate, reflective, and highly attenuating regions (arrow), as is an old plaque rupture with the absence of thrombus (double arrow). (e) Longitudinal OCT view showing old ruptured plaque within the stent, with aperture facing the direction of blood flow (double arrow). (f) Incidental finding of malapposed uncovered struts at the proximal stent segment with no evidence of thrombus. The asterisk indicates the guide-wire artifact.

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