ABSTRACT
As illustrated by slides 1-3 (runs 1-6), this is an interesting problem, which sometimes we see with drug-eluting stents and also with non drug-eluting stents. It is a case of late stent malapposition. The baseline lesion is in the proximal part of the right coronary artery, which already at the baseline has an ectatic appearance. After Cypher-stent implantation (Cordis; 3 mm), which appears undersized, we see an optimal result in run 2. The 6-month angiographic and IVUS follow-up shows persistence of the good result with the IVUS. Run 4 demonstrates that the stent is well apposed without contrast or free space behind the stent struts. The patient at this time was asymptomatic and was receiving double antiplatelet therapy. The patient returned for a scheduled 16-month angiogram and IVUS follow-up as part of the late pre-planned follow-up in a clinical study. There was an excellent angiographic result as demonstrated in run 5. Surprisingly, the IVUS evaluation at 16 months, as shown in run 6, demonstrates a large space behind the stent struts which is clearly free from any tissue as demonstrated in the direct injection during the IVUS pull back. Fortunately, this finding was not associated with any clinical event, and now, more than 2 years later, the patient continues to stay totally asymptomatic. As many studies have shown, the frequency of this problem is rare, less than 5%, and when it does occur, it does not seem to be associated with any adverse clinical event.
